Postoperative Retroperitoneal Hematoma Research Articles

A comparative study on the Efficacy of Retroperitoneoscopic Pyeloplasty and Open Surgery for Ureteropelvic Junction Obstruction in Children.

Objectives:To compare the therapeutic effect of retroperitoneoscopic dismembered pyeloplasty and open ureteropelvic junction plasty on the ureteropelvic junction obstruction (UPJO) in children.Methods:After the retrospective analysis of clinical data, 78 children with ureteropelvic junction stenosis treated from January, 2012 to June, 2018 were divided into two groups: OP (open pyeloplasty) group (38 cases) and LP (laparoscopic dismembered pyeloplasty) group (40 cases) according to the surgical methods. The operation time, intraoperative bleeding volume, postoperative length of stay (LOS), postoperative complication rate, postoperative hydronephrosis improvement and other indicators were compared between the two groups.Results:All patients underwent surgery successfully, without conversion to open surgery in LP group. The incidence of postoperative urine leakage and the recovery of hydronephrosis between LP group and OP group 12 months after operation showed no statistically significant difference (P>0.05). The intraoperative bleeding volume, the incidence of postoperative retroperitoneal hematoma, and the postoperative LOS in LP group were lower than those in OP group, while the operation time was longer than that in the OP group, with statistically significant difference (P<0.05).Conclusion:Retroperitoneoscopic dismembered pyeloplasty had similar effect with open dismembered pyeloplasty, but faster recovery and fewer complications, so it has become the preferred treatment method for UPJO in children.

Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team.

Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team. All patients underwent an open ALIF using an anterior approach to the lumbosacral spine. Results From the 227 ALIF cases, mean operative blood loss was 103 mL, ranging from 30 to 900 mL. Mean operative time was 78 minutes. The average length of stay was 5.2 days. Intraoperative vascular injury requiring primary repair with suturing occurred in 15 patients (6.6%). There were 2 cases of postoperative retroperitoneal hematoma. Three patients (1.3%) had incisional hernia requiring revision surgery; 7 (3.1%) patients had prolonged ileus (>7 days) managed conservatively. Four patients described retrograde ejaculation. Sympathetic dysfunction occurred in 15 (6.6%) patients. There were 5 (2.2%) cases of superficial wound infection treated with oral antibiotics, with no deep wound infections requiring reoperation or intravenous therapy. There were no mortalities in this series. Conclusions ALIF is a safe procedure when performed by a combined vascular surgeon and spine surgeon team with acceptably low complication rates. Our series confirms that the team approach results in short operative times and length of stay, with rapid control of intraoperative vessel injury and low overall blood loss.

Multimodal endovascular management of acute ischemic stroke in patients over 75 years old is safe and effective

IntroductionGreater attention has been directed to endovascular recanalization of acute ischemic stroke in septuagenarians and above.TechniqueA retrospective chart review was conducted to include patients treated for acute ischemic stroke from...

Role of Pararectal Retroperitoneal Approach in Abdominal Aortic Aneurysm Repair.

To evaluate the appropriate use of the pararectal retroperitoneal approach (RPA) in abdominal aortic aneurysm (AAA) repair, we retrospectively compared the RPA with the transperitoneal approach (TPA). Fifty-four patients in whom the RPA was used and 92 who had the TPA were included in the study. The mean operating time was 286 minutes with the RPA and 252 minutes with the TPA. Intraoperative blood transfusions were necessary in 9.3% of patients who had the RPA and 16.2% who had the TPA. As assessed by computerized tomographic scanning, the mean size of the postoperative retroperitoneal hematoma was 440 mL in the RPA group and 180 mL in the TPA group. Ileus resolved a mean of 3 days postoperatively in the RPA group and 5 days postoperatively in the TPA group. The mean length of postoperative hospitalization was 21 days in the RPA group and 23 days in the TPA group. Prolonged postoperative ileus occurred in no patients in the RPA group and in three patients in the TPA group. None of the differences in outcomes between the groups were significant. Our findings indicate that, in carefully selected patients, the pararectal RPA is suitable for AAA repair.

Retroperitoneal laparoscopic live donor nephrectomy: Report of 105 cases

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications. Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors. All donor nephrectomy was successful. There were no donor deaths and no conversion to open surgery. Mean operation time was 112 min (range, 70-200 min). Intraoperative blood loss was 10-150 mL with an average of 30 mL. Warm ischemia time was 1.3 to 6 min with an average of 3.1 min. Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications. Donors were discharged from the hospital 5 to 10 days postoperation. Average postoperative hospital stay was 6.4 days. One graft was removed due to acute rejection. Delayed graft function occurred in two recipients but renal function returned to normal within four weeks. The other recipients had normal renal function in two weeks except three recipients in four weeks. We believe that retroperitoneal laparoscopic live donor nephrectomy is safe, reliable, and less invasive.

Long‐term outcomes of microsurgical reconstruction for large tracheal defects

Reconstruction of large tracheal defects has been largely unsuccessful. The purpose of this study was to review the authors' experience with microsurgical reconstruction of these defects. Seven cases of microsurgical tracheal reconstruction were performed between May 2002 and April 2008. All but 1 patient had recurrent thyroid cancer; the other patient had primary adenocystic carcinoma of the trachea. The radial forearm free flap was used for lining in all cases. Rigid support was provided with a variety of prosthetic materials. All defects involved the cervical trachea, with an average length of 5.8 cm ± 1.0 cm (range, 5 cm-7.5 cm). The width of defects ranged from half of the tracheal circumference to the entire circumference. Major complications included air leak in 4 patients, exposure and removal of prosthesis in 2 patients, and cardiopulmonary complications in 2 patients. One patient with postoperative retroperitoneal hematoma, abdominal compartment syndrome, and multiple organ failure died 2 months after surgery. Two patients died of other causes 1 year and 4 years, respectively, after surgery. The other 4 patients were alive and disease free, with follow-up ranging from 1 to 4.5 years. Four patients are asymptomatic, with normal speech and swallowing functions. Two patients remained tracheostomy dependent, but vocal ability was intact. All patients tolerated a regular diet. Microsurgical reconstruction is a viable option in selected patients with large cervical tracheal defects that are beyond primary repair.

Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy

The purpose of this study was to demonstrate the clinical characteristics of postoperative retroperitoneal hematoma (RPH) following transforaminal percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent the complication of unintended hemorrhage. The medical records of 412 consecutive patients treated with transforaminal PELD between January 2005 and May 2007 were reviewed. A total of 4 patients (0.97%) experienced symptomatic postoperative RPH. The clinical outcomes were evaluated using the visual analog scale and the Oswestry Disability Index. The common symptom in all patients with a hematoma was inguinal pain. The mean hematoma volume was 527.9 ml (range 53.3-1274.1 ml). Two patients with massive diffuse-type RPHs compressing the intraabdominal structures required open hematoma evacuation performed by general surgeons, and the other 2 patients with small, localized RPHs of < 100 ml were treated conservatively. The mean follow-up period was 21.3 months (range 13-29 months). The mean visual analog scale score for radicular leg pain improved from 7.6 to 1.8 and that for back pain improved from 4.3 to 2. The mean Oswestry Disability Index improved from 58.8 to 9.1%. The preoperative symptoms improved after the second treatment without significant neurological sequelae in all patients. Although transforaminal PELD is a minimally invasive and safe procedure, the possibility of RPH should be kept in mind. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication, especially in the patient with underlying medical problems or previous operative scarring. A high index of suspicion and early detection is also important to avoid the progression of the hematoma.

Der Weg zur Etablierung der laparoskopischen Spendernephrektomie zum Standardverfahren bei der Nierenlebendspende - eine unizentrische Erfahrung

In contrast to the USA, laparoscopic donor nephrectomy is rarely practised in German transplant centres. Safety concerns and difficulties with the learning curve of this advanced laparoscopic procedure are the main obstacles to the establishment of this operation. From 1998-2005, we performed laparoscopic kidney procurement in 50 live kidney donors on an intention to treat basis harvesting a total of 29 left and 21 right kidneys for transplantation. Negative adverse effects on the donor side were temporary nerve irritation (2 patients) and postoperative retroperitoneal hematoma. Reasons to convert to open nephrectomy were bleeding (2 patients) and adhesions (1 patient). On the recipient side, one kidney was lost due to renal vein thrombosis. Three patients required short-time dialysis after transplantation. All other kidney transplants worked without any problems. Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our hospital.

Retroperitoneoscopic Nephrectomy for Autosomal Dominant Polycystic Kidney Disease: Initial Experience

Introduction: Nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) has been reported to have significant morbidity and mortality. Because of the large kidney size, laparoscopic nephrectomy is technically demanding and there have been only few reports on this subject. We describe our retroperitoneoscopic technique and review the literature. Methods: Retroperitoneoscopic nephrectomy was performed in 2 patients. A four-port retroperitoneal access was used, after hilar control the kidney was freed and extracted. Results: The mean operative time was 155 min, the mean intraoperative blood loss was 125 ml. There were no intraoperative complications. A postoperative retroperitoneal hematoma in 1 of the patients was managed conservatively with transfusion. Conclusion: Retroperitoneoscopic nephrectomy for ADPKD is feasible. The main advantages of this technique compared to transperitoneal laparoscopy are the quick and easy access to the hilar vessels even in large polycystic kidneys and the strict extraperitoneal route.

Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital

Laparoscopic live donor nephrectomy has become the new gold standard for kidney procurement in many high-volume transplant centres worldwide, but it is often limited to left-sided donor kidneys. Concerns about adequate anatomical renal vessel length and sufficient surgical exposure are the main obstacles to the use of the laparoscopic approach for right kidney live donors as well. From 1998 to 2006 we performed laparoscopic kidney procurement in 73 live kidney donors on an intention-to-treat basis, harvesting a total of 48 left (LKG) and 25 right kidneys (RKG) for transplantation. We compared these two groups with respect to operating time, conversion rate, complications, hospital stay, and recipient outcome. There were no differences in outcome of donor patients after left (D-LKG) or right laparoscopic donor nephrectomy (D-RKG). Operating time was 160 min in D-RKG versus 164 min in D-LKG. Warm ischemia was below 150 s in both groups. Hospital stay was 7.0 (D-RKG) versus 6.7 days (D-LKG). Negative events on the donor site were one temporary nerve irritation in each group and one postoperative retroperitoneal hematoma in the left kidney group. Reasons to convert to open nephrectomy were bleeding in two patients in the left kidney group and adhesions in one patient in the right kidney group. The outcome of the recipients after left (R-LKG) or right kidney (R-RKG) transplantation was similar. One kidney was lost due to renal vein thrombosis (R-LKG). Postoperative ureter complications occurred in one patient of each group. One patient of the R-RKG and two patients of the R-LKG required lymphocele fenestration. All other kidney transplants worked without problems. Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our clinic. Laparoscopic procurement of right and left kidneys can be performed with comparable quality and outcome for donors and recipients.

Role of Pararectal Retroperitoneal Approach in Abdominal Aortic Aneurysm Repair

To evaluate the appropriate use of the pararectal retroperitoneal approach (RPA) in abdominal aortic aneurysm (AAA) repair, we retrospectively compared the RPA with the transperitoneal approach (TPA). Fifty-four patients in whom the RPA was used and 92 who had the TPA were included in the study. The mean operating time was 286 minutes with the RPA and 252 minutes with the TPA. Intraoperative blood transfusions were necessary in 9.3% of patients who had the RPA and 16.2% who had the TPA. As assessed by computerized tomographic scanning, the mean size of the postoperative retroperitoneal hematoma was 440 mL in the RPA group and 180 mL in the TPA group. Ileus resolved a mean of 3 days postoperatively in the RPA group and 5 days postoperatively in the TPA group. The mean length of postoperative hospitalization was 21 days in the RPA group and 23 days in the TPA group. Prolonged postoperative ileus occurred in no patients in the RPA group and in three patients in the TPA group. None of the differences in outcomes between the groups were significant. Our findings indicate that, in carefully selected patients, the pararectal RPA is suitable for AAA repair.

Extraperitoneal laparoscopic adrenalectomy: the initial 9 cases

(PURPOSE). To determine the efficacy of extraperitoneal laparoscopic adrenalectomy for patients with adrenal tumor, the clinical results of 9 patients treated with this procedure were analysed. (PATIENT AND METHOD). Between July 1994 and March 1995, we have performed extraperitoneal laparoscopic adrenalectomy using the modified Gaur technique of balloon dilatation of the retroperitoneum in 4 men and 5 women with unilaterla small adrenal tumor who were 30 to 79 years old (mean age 56 years). Preoperative diagnosis was primary aldosteronism in 2, 18-hydroxycorticosterone producing adnoma in 1, pre-Cushing syndrome in 5, and nonfunctioning adrenal tumor in 1 patient. The operations were performed with the patients on lateral position and 4 torocars were positioned. The retroperitoneal space was first dissected bluntly by the index finger and a balloon dissector through a small skin incision, and the retroperitoneal space was insufflated with carbon dioxide at the pressure of 10 to 12 mmHg. After the dissection of the adrenal gland, adrenal vein was clipped and transected. The completely freed adrenal gland was enclosed in an entrapment sack and removed en bloc through the open laparoscopy wound. (RESULTS). All 9 procedures were successfully performed. The mean estimated blood loss and the mean operating time were 53 ml and 168 min respectively. There was no intraoperative complication. A postoperative retroperitoneal hematoma was observed in one patient, however it spontaneously resolved without surgical management. (CONCLUSION). In open adrenalectomy, the benefit of the extraperitoneal approach (excluding patients with pheochromocytoma or bilateral lesions) have already been established elsewhere. Although the working space is smaller than that of peritoneal approach, and the surgical techniques are slightly more difficult, extraperitoneal laparoscopic adrenalectomy promises to be safe and a minimally invasive treatment for patients with unilateral small adrenal tumors except for pheochromocytoma.

Laparoscopic Ablation of Symptomatic Renal Cysts

We report a laparoscopic approach to the drainage and ablation of symptomatic simple renal cysts. Ten patients with chronic pain, 6 of whom failed primary aspiration, underwent laparoscopic cyst ablation: 6 had solitary renal cysts, 3 had multiple cysts and 1 had a peripelvic cyst. The approach was transabdominal in 9 patients and extraperitoneal in 1. Intraoperatively, cyst fluid was obtained for cytological examination, and cyst walls were excised and sent for pathological examination. When possible, the remaining inner cyst walls were fulgurated to prevent recurrence. Mean total operating room time was 2hours 27minutes and blood loss was minimal. The sole complication was a postoperative retroperitoneal hematoma, which was managed conservatively. Malignancy was diagnosed in 2 patients, each of whom had a negative preoperative aspiration. These patients subsequently underwent radical nephrectomy. All remaining patients were asymptomatic at a mean followup of 10 months. Laparoscopic ablation of renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Preoperative and intraoperative evaluation for malignancy should be performed.