Mean Hospital-stay Research Articles

Comparative Analysis of Mean Hospital Stay in Patients Undergoing Percutaneous Nephrolithotomy (PCNL) With Versus Without Nephrostomy Tube

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for the removal of large renal calculi. The use of nephrostomy tubes postoperatively is common; however, they may increase hospital stay and patient discomfort. Tubeless PCNL has emerged as a potential alternative.Objective: To compare the mean hospital stay in patients undergoing PCNL with and without a nephrostomy tube.Methods: A prospective cohort study was conducted on 60 patients undergoing PCNL at the Armed Forces Institute of Urology, Rawalpindi, from June to December 2020. Patients were divided into two groups: Group A (PCNL with nephrostomy tube) and Group B (tubeless PCNL). Both groups were assessed for mean hospital stay, postoperative complications, and stone size using SPSS version 25. Inclusion criteria were age ≥18 years, stone size of 2-3 cm, and ASA I-II. Exclusion criteria included prior renal surgeries and comorbidities.Results: The mean hospital stay was significantly shorter in Group B (1.90 ± 0.80 days) compared to Group A (2.46 ± 0.81 days, p=0.0001).Conclusion: Tubeless PCNL significantly reduces hospital stay compared to standard PCNL.

ANALYSIS OF EFFICACY OF COLLAGEN DRESSING VERSUS CONVENTIONAL DRESSING IN CHRONIC WOUND

A breach in continuity of the covering epithelium either of skin or of mucus membrane is defined as ulcer. Chronic or non-healing ulcers are defined as ulcers that are unresponsive to initial treatment or that persist for more than 3 weeks after appropriate care and management. Chronic nonhealing ulcers not only have a medical challenge but have social, economical and occupational effects on the patient. Ulcers have been treated conventionally by cleansing, debridement and removal of necrotic and infected tissue which was followed by dressing with topical antiseptic like Povidone iodine, antibiotic ointment, silver ointment, etc. Collagen is a group of naturally occurring proteins found in all phases of wound healing. Collagen is a key component of extracellular matrix which plays critical roles in the regulation of the phases of wound healing in its native fibrillar conformation or as a soluble component.Collagen helps wound healing through deposition and organisation of freshly formed fibres and granulation tissue in the wound bed which creates a good environment for wound healing.Collagen sheets when applied to a wound promote angiogenesis and also enhance bodyÂ’s repair mechanisms Our Aim is To compare the efficacy of the conventional dressing and collagen dressing in chronic wound in terms of Average time required for appearance of Granulation tissue, Requirement of Skin Grafting and mean Hospital Stay. Based on the type of dressing used, patients were divided into 2 groups, Group A(49) patients were dressed with conventional dressing, Group B patients (51) were dressed with collagen making a total of 100 patients. Appearance of healthy granulation tissue was observed to be significantly earlier among patients of collagen dressing group as compared to other group .The observed difference between number of days of hospital stay of patients with collagen dressing was statistically significant as compared to other group Thus Collagen based dressing were observed to be superior from conventional dressings in terms of aspects of healing viz. appearance of healthy granulation tissue.

Comparison of Mean Hospital Stay after Nebulization with 3% Hypertonic Saline vs Salbutamol in Treatment of Bronchiolitis

Abstract: Background: With an estimated prevalence of 33% in children age >2years and owing to 1 in 10th cause of hospitalization in children, Bronchiolitis is a major factor for morbidity and mortality. Varying nebulization doses have been shown to produce different clinical outcomes in patients with bronchiolitis. Objective: To compare mean hospital stay after nebulization with 3% hypertonic saline compared to the salbutamol among patients of bronchiolitis Materials and Methods: This was a randomized control study done at pediatric medicine ward, Services Hospital, Lahore. The study was done during 8th May 2018 to 8th November 2018. Data was collected from 68 children of age >3 months to < 2 years of both genders i.e. (34 in each group) fulfilling inclusion criteria. SPSS software was used for data entry and analysis. For quantitative variables age, mean and standard deviation were used whereas for qualitative variables like gender, frequency and percentages were used. Independent sample t-test was used for comparing mean hospital stay among the two groups taking p-value<0.05 as significant. Result: Average age in Salbutamol group was 1.06 ± 0.50 years and in Hypertonic solution mean age was 1.24 ± 0.55 years. There was significant difference in mean hospital stay with relatively lesser in hypertonic solution vs the Salbutamol group [3.18 ± 1.11 vs 4.44 ± 1.08 ; p-value <0.001]. Upon post-stratification analysis, the mean hospital stay was found to be significantly lower in the Hypertonic group vs. Salbutamol group with respect to age, gender and the duration of the disease (p-values<0.05 for all). Conclusion: This study concludes that the mean hospital stay was statistically lower in the hypertonic solution group vs the Salbutamol group. Moreover, the clinical efficacy of the hypertonic saline can be utilized in future to gain early recovery of Bronchiolitis and hence it can reduce the hospital stay and related cost. Keywords: Bronchiolitis, Salbutamol, Hypertonic saline, Hospital stay, Severity, Duration, Treatment.

Ureteric Stones less than 1.5 Cm: Comparison of Laser Vs. Pneumatic Lithotripsy: A Single Center Study

Background: Ureterorenoscopy (URS) and intracorporeal lithotripsy (ICL) is the first-choice treatment for ureteric stones less than 1.5 cm. Various options forintracorporeal lithotripsy exist such as pneumatic, Laser and Ultrasonic. Aim: To assess the safety and efficacy of laser versus pneumatic lithotripsy in treating ureteric stones of less than 1.5cm via Ureterorenoscopy. Methods: A total of 182 patients who underwent URS and intracorporeal in the department of UROLOGY LRH to were reviewed retrospectively from December 2021-December 2022 after ethical approval. Two groups were made on the basis of type oflithotripsy used (112 patients in the pneumatic lithotripsy (PL) group and 70 patients in the Laser lithotripsy (LL) group. Stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), and complications rate were evaluated for both groups. Results: Mean age of LL Patients was 41.1±3.9 years and PL patients 38.2±4.5 years. 68.4% of the study participants were males. LL had more upper ureter stones 17 (24.4%). LL's drawbacks outweighed its benefits in treating proximal ureteral calculi. Table 2 outlines postoperative complications and efficacy. Comparing the complications more PL patients had ureteric perforations (4.4%), postoperative fever (2.9%) and mucosal injury (5.7%) with p-value ≥0.05%. Mean operation time and hospital stay were less in LL patients, an immediate stone-free rate more (93.3%) in LL patients while stone migration more in PL patients 20(28.6%) with a statistically significant (p-value ≤0.05). Practical implication: Patients with renal stones will easily be treated with laser and pneumatic with less complications rate and short hospital stay than open surgery. Conclusion: For the treatment of ureteral stones, the PL and LL methods were effective and safe. However, it's possible that the LL class' SFR was higher.. Keywords: Ureteric Stones, Laser Lithotripsy, Pneumatic Lithotripsy, Comparison

Effect Of Laparoscopic Sleeve Gastrectomy On Vitamin D, Parathormone Hormone, And Serum Calcium Levels.

To evaluate the effect of laparoscopic sleeve gastrectomy on vitamin D status, parathyroid hormone,serum calcium and the effectiveness of vitamin D supplementation. The prospective study was conducted at the General Surgery Department of Kafrelsheikh University Hospital, Egypt, in November 2019, and comprised morbidly obese patients of either gender who were managed with laparoscopic sleeve gastrectomy. Serum levels of vitamin D, calcium and parathyroid hormone were assessed at baseline and at 6 and 12 months after the surgery. All subjects were given 400 IU/day of vitamin D. If the level of vitamin D was <30ng/ml, further doses of calcifediol 200,000 IU were added every two weeks. Data was analysed using SPSS 22. Of the 40 patients, 28(70%) were females and 12(30%) were males. The overall mean age was 33.9±10.8, mean weight was 136±18.29kg and mean body massindex was 50±4.9kg/m2 . The mean operative time was 64.5±13.6 minutes, and the mean hospitalstay was 1.8±1.1 days. There wassignificant reduction in body massindex values after the surgery (p<0.05). Vitamin D level was 19.2±3.2 ng/ml at baseline, which rose to 21.4±2.7 ng/ml at 6 months and 26.6±2.8 ng/ml at 12 months post-surgery (p<0.05). Preoperative parathyroid hormone level was 58.3±7.8 pg/ml , which went down to 48.6±7.4 pg/ml at 6 months, and 41.3±6.5 pg/ml at 12 months postoperatively (p<0.05). The mean serum calcium level at baseline was 9±0.4mg/dL, which rose to 9.2 ±0.3mg/dL and 9.5±0.4 mg/dL at 6 and 12 months post-surgery (p<0.05). Low vitamin D complications could be decreased postoperatively by administering vitamin D as a routine treatment. Postoperative monitoring of vitamin D, parathyroid hormone and serum calcium levels is essential.

Retroperitoneal soft tissue Sarcomas: retrospective cohort study

Objective: Soft Tissue Sarcomas are rare mesenchymal tumors with many subtypes. Clean margin wide resection is recommended for treatment.In this study, the location, histopathological features, clinical and demographic features, recurrence and prognosis of retroperitoneal sarcomas were investigated. Methods: The demographic, histopathological and immunohistochemical data of 18 patients who were operated on with the diagnosis of retroperitoneal mass between March 2016 and June 2021 were evaluated retrospectively. Results: 18 patients were included in the study. 10 patients were male and 8 patients were female. The mean age was 57 (23-81), the median age was 55. While 14 patients were primary sarcoma, 4 patients were recurrent sarcoma. The most common complaint was abdominal pain with 38,87%. The average follow-up time was 26 (0-55) months. The postoperative mean hospitalstay was 5,83 (2-8) days. The average size of the tumor was 19,81 (6,5-36) cm. A total of 8 different histopathological sarcoma types were detected. The most common histology was Dedifferentiated Liposarcoma (44,45%). R0 resection in 10 patients, R1 resection in 6 patients and R2 resection in 2 patient were performed. Organ resection was performed in 6 patients due to organ invasion. During follow-up, 10 patients had a local recurrence and underwent reresection and 6 patients died. The 30-day mortality number was 0. The mean time to detect relapse was 9,3 (1-55) months. Metastasis developed in 2 (11, 11%) patients. Conclusion:Although we are a low-volume hospital for retroperitoneal sarcomas, our results are similar to those in the literature. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 829-835

Prognostic Nutritional Index in Short-term Postoperative Outcomes in Hepaticojejunostomy.

To investigate the utility of prognostic nutritional index (PNI) on short-term complications, biliary fistula, mortality, and morbidity in patients undergoing hepaticojejunostomy (HJ) procedure. Observational study. Tepecik Training and Research Hospital, Izmir, Turkey, between January 2018 and January 2020. Patients who underwent elective HJ for benign and malignant reasons were scanned retrospectively using the hospital digital record system. Many data such as chronic diseases and PNI values of patients, postoperative 30-day mortality and morbidity, days of hospital stay (HS), postoperative complications, and data of surgery were analyzed. A total of 81 patients, of whom 42 (52%) were males and 39 (48%) were females, were included in the study. The mean age of the patients was 65.8 ±11.3. In 53 patients (65.4%), surgeries were performed due to malignancy. In 19 (23.4%) patients, grade 3 and 4 complications according to Clavien-Dindo Classification were observed in 12 patients (14.8%), and postoperative 30-day mortality was observed. The rate of grade 3 and 4 complications increased in patients with a PNI below 45, it was not statistically significant (p=0.165). The mortality rate was 4.5% in patients with PNI>45, and 18.6% in patients with PNI<45 but this difference was not significant (p=0.165). The mean HS was significantly shorter in patients with PNI>45 (p=0.02). At PNI>45, many complications and hospital stay become markedly shorter. Large multi-centre randomised future studies are required to confirm these findings. Prognostic nutritional index, Hepatic duct, Biliary tract, Biliary fistula.

Diagnosis and Management of Acute Limb Ischemia

Introduction: Acute limb ischemia is considered as a life threatening disease .After twelve hours of ischemia, chances of saving the ischemic limb are lower (78%), with higher mortality (31%) as well. Methods: A total of 54 patients who underwent surgery for acute non traumatic limb ischemia between January 2013 and December 2020 were retrospectively reviewed. Results: We included 30 women and 24 men; median age was 69 years. Twenty patients (37%) were presented with upper limb ischemia, where as 34 patients (63%) with lower limb ischemia. Mean delay between the onset of symptoms and hospital admission of upper limb ischemia was 22 hours, 35% of Patients were diagnosed at the stage IIA of Rutherford classification, while 65% were diagnosed at the stage of II B. Lower limb ischemia patients were admitted after 28.5 hours, 64.8% of patients were diagnosed at the stage of II A of Rutherford, while 32.3% were diagnosed at the stage of II B of Rutherford. Revascularization of all ischemic upper limbs (100%) and the majority of ischemic lower limbs (94.1%) were carried out through endovascular thromboembolectomy with Fogarty ballooncathete. Meanlength of hospitalstaywas 8.3 days for upper limb ischemia cases ; while lower limb ischemia patients required 9.2 days of mean hospitalstay. We report a total of 4 deaths (7.4%). Conclusion: Acute limb ischemia remains a challenging entity for clinicians with significant risk of patient limbloss and mortality. Prompt diagnosis, anticoagulation, and timely revascularization are crucial to minimize the risk of limbloss.

A STUDY ON CORRELATION OF ACIDEMIA WITH PATIENTS 30 DAYS MORTALITY THOSE PRESENTING TO EMERGENCY DEPARTMENT OF A TERTIARY HOSPITAL

Introduction: Acidosis is a process causing increased acidity in the blood and other body tissues (i.e., an increase in hydrogen ion concentration). If not further qualied, it usually refers to acidity of the blood plasma Acidemia is said to occur when arterial pH falls below 7.35 , while its counterpart (alkalemia) occurs at a pH over 7.45. Arterial blood gas analysis and other tests are required to separate the main causes.Aims: To nd out correlation between different grades of Acidemia with 30 day mortality of patient diagnosed as academic in emergency department Materials and method: This was a single center observational, retrospective cohort study from tertiary care hospital in Kolkata, India from January 2021 – January – 2022. All Patients were presenting with signs of Acidemia in Emergency Department. Age &gt;18 years, Blood gas analysis, Done in ED and pH ≤ 7.34 were included in this study. Result: In mortality, 33(32.4%) patients were in &lt;7.0 PH group, 31(30.4%) patients were in 7.0-7.10 PH group, 23 (22.5%) patients were in 7.11-7.20 PH group and 15 (14.7%) patients were in 7.21-7.34 PH group. Association of PH group with Mortality was statistically signicant (p&lt;0.0001). In without Mortality, the mean Age (mean± s.d.) of patients was 57.0268 ±9.2811. In with Mortality, the mean Age (mean± s.d.) of patients was 56.2549±9.0758. Distribution of mean Age with Mortality was not statistically signicant (p=0.4506). In without Mortality, the mean PH (mean± s.d.) of patients was 7.1898 ±.1189. In with Mortality, the mean PH (mean± s.d.) of patients was 6.9708 ±.2907. Distribution of mean PH with Mortality was statistically signicant (p&lt;0.0001). In without Mortality, the mean Hospital Stay (mean± s.d.) of patients was 14.1512 ±5.5302. In with Mortality, the mean Hospital Stay (mean± s.d.) of patients was 7.4804 ±6.1010. Distribution of mean Hospital Stay with Mortality was statistically signicant (p&lt;0.0001). Conclusion: Patients presenting in emergency with low PH (acidemia) require immediate management and hospitalization for better outcome.

Alternative Endograft Aortoiliac Reconstruction for Iliac Branch Endoprostheses

Endovascular treatment of complex common iliac artery (CIA) and internal iliac artery (IIA) aneurysms using iliac branch endoprostheses (IBE) has proven safe and effective. Instructions for use (IFU) require deployment of current IBE technology with the corresponding manufacturer's modular bifurcated aortic endograft. Concomitant aortoiliac occlusive disease, inadequate renal artery-iliac bifurcation length, and unfavorable aortic anatomy preclude on-label IBE deployment. This study aimed to evaluate the technical feasibility and safety of Alternative Endograft Aortoiliac Reconstruction (AEGAR) for branched endovascular treatment of complex iliac artery aneurysms. In 7 consecutive patients with CIA or IIA aneurysms, computed tomography angiography (CTA) and center-line reconstruction revealed aortoiliac anatomy incompatible with the current IBE IFU due to inadequate proximal CIA landing zone (n=7), inadequate renal artery to iliac bifurcation length (n=2), compromised aortic anatomy (n=3), or short infrarenal neck <15 mm (n=1), either alone or in combination. To overcome these restrictions and facilitate IBE deployment, aortoiliac reconstruction was performed using the Endologix AFX, Endologix Ovation limbs or the Medtronic Endurant II platforms (AEGAR technique). All internal iliac artery reconstructions and external iliac artery extensions were performed using the Gore VBX or Viabahn stent grafts. Technical success was defined as successful delivery of all endograft components without migration or endoleak. The mean patient age was 69 years (range 52-82 years; 6 male). Four patients had bilateral CIA aneurysms and 3 patients had unilateral CIA aneurysms (mean diameter 4.3cm; range 2.2-7 cm). There were 13 IIA VBX stent grafts used for a total of 9 IIAs treated with IBE (bilateral IBE=2 patients). The mean fluoroscopy time was 38.8 min (range 21.3-64.3 min) and the mean contrast volume was 168.5 mL (range 122-226 mL). Technical success was achieved in all patients and there were no perioperative complications. Mean hospital-stay was 2.2 days (range 1-3 days). Follow-up ranged from 82-957 days (mean=487 days). At last follow-up, all patients were alive without cardiovascular morbidity; and CTA revealed stable or decreased aneurysm size, patent endografts, and no evidence of endoleak or migration. The AEGAR technique can be used to safely and effectively overcome certain aortoiliac anatomic constraints that preclude use of current IBE technology. We encourage broader use of these alternative endografts in pertinent anatomic configurations.

A COMPARATIVE STUDY BETWEEN ONLAY AND RETRORECTUS MESH REPAIR IN THE TREATMENT OF INCISIONAL HERNIAS

INTRODUCTION: Over the years, surgeons tried the placement of mesh at different locations like On-lay, Under-lay, Sub-lay and pre-peritoneal, retroperitoneal intraperitoneal, Inter-muscular, etc. with each procedure having its advantages and disadvantages. Commonly Onlay and sub lay mesh repairs are done. Though the literature says, sub lay procedures have fewer complications and a high success rate. However, in a few studies, the ideal position for mesh repair appears to be retro muscular, where the force of abdominal pressure holds the mesh against deep surfaces of muscles. In this study, a comparison of both Onlay and retro rectus procedures with regards to the duration of surgery, postoperative complications like seroma, wound infection, wound dehiscence, and also the period of postoperative stay in the hospital. The aim of the study is To compare 'Onlay' versus 'retro rectus' mesh repair in inuencing the outcome in incisional hernia with regards to Duration of surgery, Postoperative complications like seroma formation, wound infection, Postoperative stay, Recurrences. PATIENTS AND METHODOLOGY: Type of Study: A Prospective comparative study Study Setting: Department of general surgery, Narayana Medical College &amp; Hospital, Nellore.Study Period: November 2018 to September 2020 Study Sample: 50 cases, divided into two groups by random allocation technique. Groups A and B with 25 patients in each group. RESULTS: The mean age of cases in Group A is 40.48 years. The mean age of patients in Group B is 44.08 years. Youngest was 31 years and 36 years in group A and group B, respectively, and the eldest was 51 years and 53 years in group A and group B, respectively. In Group A, 11 were male, and 14 were female, and in Group B, 11 were male, and 14 were female. The male to female ratio in the study was 1:1.27. The mean Operative Time in Group A was 1.93 Hrs, and that in Group B was 2.98Hrs. Nine patients (36%) in group A and one patient (4%) in group B had seroma formation. Eight patients (32%) in group A and one patient (4%) in group B had a wound infection. The mean Hospital Stay in Group A was 5.44 Days, and Group B was 4.88 days. No short-term recurrences were noted in either of the two groups when followed for six months. CONCLUSION : Retrorectus mesh repair is an excellent alternative to Onlay mesh repair that may apply to incisional hernia. The mesh-related overall complication rate like seroma wound infections and hospital stay is less than Onlay mesh repair.

Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases.

Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.

Simultaneous surgery for concomitant lung cancer and diffuse coronary atherosclerosis

To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease. We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (n=21) or long segmental coronary artery reconstruction (n=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (n=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients. CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (n=6, 16.6%), re-exploration for bleeding (n=1, 2.7%), pneumonia (n=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21). Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.

Initial experience of robot-assisted minimally invasive McKeown esophagectomy

To report our initial experience of robot-assisted McKeown esophagectomy with stapled cervical esophagogastrostomy. There were 5 robot-assisted McKeown esophagectomies in patients with benign end-staged and malignant diseases of the esophagus for the period from October 2019 to February 2020. No conversions and intraoperative complications were observed. Mean surgery time was 406±48 min, total intraoperative blood loss - 108±45 ml. Four patients had minor complications (wound infection, atelectasis, pneumothorax) that required conservative treatment. We have controlled anastomosis in 2-3 postoperative days with water-soluble contrast, none patient had an anastomotic leakage. Mean hospital-stay was 5 days. Complete (R0) resection was accomplished in all patients with malignant neoplasms. Our first experience showed that robot-assisted McKeown esophagectomy is a safe and feasible surgical option for esophageal diseases. Robot-assisted interventions require advanced endoscopic surgical experience.

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyema. Diagnosis was confirmed with CT scan and drainage of frank pus from the chest tube. All patients underwent chest tube insertion and antibiotic therapy nonetheless 9 of them required surgical management with VATS or open decortication. Results and Conclusion: The impedance in seeking medical advice due to fear of COVID-19 and the insufficiency of an interdisciplinary approach in the management of those patients were determined as the reason for such high admittance with stage III empyema. The decision of open vs VATS decortication was made based on the medical status and history of each individual, the stage of the empyema and ultimately our ability to achieve the two primary goals of empyema treatment, complete evacuation, and lung reexpansion [1]. Eight patients underwent open decortication and drainage and one managed with VATS decortication. Postoperative complications were encountered in 3 patients which included prolonged air leak, surgical wound infection, and septic shock. One patient died from multiple organ failure due to postoperative septic shock. The duration of chest tube drainage varied from 5-15 days. The mean hospital stay was 13,5 days.

Safety and feasibility of a systematic transradial-access program for percutaneous coronary intervention in chronic total occlusions

Abstract Aims To evaluate the safety and feasibility of a transradial-access PCI program in CTO and its impact on angiographic and clinical results and in-hospital stay length. Methods Retrospective single-centre cohort-study including 237 consecutive patients undergoing CTO-PCI. From November 2018 onwards, a transradial-access program and all first-attempt CTO-PCI procedures were systematically performed via the radial artery. 47 patients included in the transradial-access CTO-PCI program were compared to a historical cohort of 190 CTO-PCI patients, employing transfemoral access mainly: n=150 (78.9%). Results Mean age was 66.9±11.4 and 199 (83.9%) patients were male, Table 1. Mean J-CTO score (2.5±1.1) was similar in both groups. Successful revascularization was achieved in 208 (87.8%) cases overall, without differences between both cohorts. No differences in periprocedural complications between both groups existed, but in-hospital complications were numerically lower in the transradial cohort (4.3% vs 13.7%, p=0.072). Mean hospital-stay was lower in the transradial-access group (0.89±1.4 vs 2.2±3.2 days, p&amp;lt;0,001). Same-day discharge was successfully accomplished in 56% of elective patients in the transradial-access program, Figure 1. Conclusion A transradial program for CTO-PCI is safe and effective in most CTO. Adoption of a transradial protocol for CTO-PCI allows same-day hospital discharge in over half of elective procedures and reduces in-hospital stay length. Figure 1. Same-day discharge in both cohorts Funding Acknowledgement Type of funding source: None

Simultaneous laparoscopic procedures in patients with synchronous multiple primary gastric and kidney cancer

To evaluate an effectiveness of simultaneous laparoscopic procedures in patients with synchronous multiple primary cancer (SMPC). We observed 3 patients (2 men and 1 woman) aged 61-78 years with synchronous multiple primary gastric and kidney cancer. Gastric tumors were localized in the lower third of the body (1) and the antrum (2), histological structure corresponded to adenocarcinoma G1 (1) and G2 (2). Kidney tumors were verified as light cell carcinoma and localized in the upper segment of the left kidney in 2 patient and right kidney in one patient. Mean dimension of tumor scheduled for resection was 4.65 cm, nephrectomy - 10.3 cm. Complexity of resection according to the RENAL scale was equal to 8 and 10. Three patients underwent laparoscopic Billroth-I distal gastrectomy, 2 - kidney resection and one patient - nephrectomy. Mean surgery time was 265±37 min, blood loss - 175±29 ml. There were no conversion and redo interventions within 30 days after surgery. Mean hospital-stay was 11±2 days. Minimally invasive technologies in patients with SMPC reduces blood loss, ICU- and hospital-stay. Earlier rehabilitation ensures the next stage of treatment in early postoperative period, while quality of life is better in comparison with traditional interventions.

ERAS protocol for perioperative management of patients with non-small cell lung cancer

To evaluate an effectiveness of enhanced recovery program for perioperative support of patients with lung cancer. A prospective single-center study on effectiveness of ERAS protocol in perioperative support of patients with lung cancer was conducted at the Tomsk Regional Cancer Center. According to the study design, patients were divided into three groups. The first group included patients after VATS surgery followed by accelerated recovery. The second and the third groups comprised of patients after open interventions. In these groups, patients were randomized into traditional management or accelerated recovery management groups using the blind envelope method. Patients with indicated lobectomy or bilobectomy were included only. In postoperative period, we analyzed morbidity, pain syndrome and hospital-stay. A total of 235 patients were treated. VATS surgery followed by enhanced recovery program was applied in 61 patients. Eighty-seven patients underwent open operations followed by accelerated recovery protocol and traditional management. ERAS protocol ensured less postoperative morbidity compared to traditional management (p<0.001). Pain syndrome was less pronounced after VATS surgery and did not require an appointment of narcotic analgesics. In the group of open surgery followed by accelerated recovery protocol, narcotic analgesics within 3 postoperative days were required in 38 (43.6%) cases, in the group of traditional management - in 63 (72.4%) patients. Mean postoperative hospital-stay after VATS operations was 6.4 days, after open interventions followed by ERAS protocol - 8.7 days. In patients after open surgery and traditional postoperative management, mean hospital-stay was 14.2 days. One patient died after open surgery followed by ERAS protocol and 3 patients died in the group of traditional management. ERAS protocol ensures less postoperative morbidity, early activation of patients and reduced hospital-stay.

Outcomes of Retrograde Intra-Renal Surgery

Introduction: Miniaturization of endoscopic instruments has gained wide popularity in the treatment of renal calculi. Retrograde intra-renal surgery and holmium laser in combination has already proven its superiority when compared to other modalities in the treatment of renal calculi. This study was conducted to assess the outcome of retrograde intra-renal surgery in renal stone disease.Materials and Methods: This retrospective study analyzed the outcome of retrograde intra-renal surgery in renal stone less than 2 cm size in the adults above 18 years of age from September 2018 to August 2019 at Patan Hospital, Nepal. The outcome was assessed descriptively on postoperative pain and fever, stone localization, stone size, stone clearance, urosepsis, operative time, hospital stay, mortality, need of the second procedure.Results: A total of 62 patients underwent retrograde intrarenal surgery, out of which 48 cases were included. The mean age of the study population was 32.4± 14 years (19-68 years). Similarly, the mean operative time was 68± 12 (48-124 minutes) and mean hospital-stay was 3.2± 1.1 days. Postoperative pain and fever were observed in 14 (29.16%) &amp; 4(8.33%) patients respectively. Hematuria occurred in 6(12.50%) and urosepsis in 2(4.16%) of the patients. Complete stone clearance was achieved in 34(70.83%) and residual stones were present in 8(16.66%) and clinically insignificant radiological fragments were present in 6(12.50%) patients.Conclusions: Retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal calculi, with minimal post-surgical morbidity.

P210 HYBRID LAPAROSCOPIC ROBOT-ASSISTED MINIMALLY-INVASIVE ESOPHAGECTOMY: A PROSPECTIVE EXPERIENCE IN A REFERRAL CENTER

Abstract Aim To report the prospective experience in Hybrid Laparoscopic Robot-assisted Minimally-invasive Esophagectomy (HLRAMIE) in a referral Center. Background &amp; Methods The minimally-invasive esophagectomy (MIE) is an attractive and established technique to improve the reduction of post-operative morbility with sound oncological results. The hybrid combination of laparoscopy and full robotic thoracic phase (HLRAMIE) is an approach aimed to be as effective as MIE to treat esophageal neoplasms. Inclusion criteria: patients undergone to multimodal medical advice panel, affected from non-cT4, from mid thoracic to cardia, esophageal neoplasms, with and without neoadjuvant treatment, fit for minimally-invasive surgery. HLRAMIE: laparoscopic stage plus full robotic thoracic stage by Da Vinci Xi® (Intuitive Surgical, US), with gastric-pull first-choice conduit. Prospective, dedicated database. Results From October 2015 to April 2019, 33 patients underwent to HLRAMIE (site of neoplasm: 1 mid thoracic; 9 inferior; 23 cardia). 5 out 33 were converted to open. 27/28 underwent to a Ivor Lewis esophagectomy, 1/28 to McKeown procedure. The mean total surgical time was 517 minutes, mean robotic docking time 12 min with mean thoracic time 269 min (positive trend). Gastric pull-up was performed in 28/28. In 23/28 patients the esophago-gastric anastomosis was performed full robotic after the fashion of hand, in 5/28 was performed by circular stapler. The mean extubation time was 12 hours. The mean number of lymph node removed was: overall fields 32.4 (range 15-58), thorax 9.8 (3-27). The mean number of metastatic lymph node was 3.8 (0-18). 100% were R0 resections. The mean hospital-stay was 15 days. The perioperative mortality and 30-day mortality were both 0%. The overall post-operative morbility was 32.1%. 4/28 (14.2%) patients developed an anastomotic leakage, 75% were managed by endoscopy. 11/28 (39.2%) patients developed a late anastomotic stenosis (all in the hand made group). Conclusion In our experience, HLRAMIE is surgically reproducible with the principle of learning curve; oncologically adequate in relation to radical dissection; safe and effective in relation to post-operative early morbility and mortality. Long-term follow up and more powerful, randomized series are needed to establish the definitive clinical and oncological results of HLRAMIE.