Significant Difference In Overall Morbidity Research Articles

Extraperitoneal sigmoidopexy versus sigmoidectomy for sigmoid volvulus: A prospective comparative study

AbstractAimExtraperitoneal sigmoidopexy is a simple, safe and effective non‐resective procedure with minimal morbidity and mortality rates.Patients and MethodsThis prospective comparative study involved 105 patients with uncomplicated sigmoid volvulus at Asyut University Hospitals, Egypt, from June 2021 to January 2023. The study population was divided into two groups: Group A, which underwent extraperitoneal sigmoidopexy, and Group B, which was treated with sigmoidectomy and primary anastomosis.ResultsThe study included 105 cases. A total of 56 (53.4%) patients underwent extraperitoneal sigmoidopexy (Group A) and 49 (46.6%) patients underwent sigmoidectomy (Group B). The mean age was 61.33 (standard deviation [SD] 1.65) for Group A and 67.9 (SD 1.69) for Group B (P = .36). The mean operative time (minutes) was 62.25 (SD 1.38) for Group A and 87.60 (SD 2.38) for Group B (P < .0001). The mean hospital stay (days) was 6.25 (SD 0.29) for Group A and 9.04 (SD 0.34) for Group B (P < .0001). There was a significant difference in overall morbidity and recurrence rate, while no significant difference was observed in intensive care unit admission, additional surgery and mortality between the two groups.ConclusionExtraperitoneal sigmoidopexy emerges as a simple, safe and effective treatment option for non‐complicated sigmoid volvulus. Despite a higher recurrence rate, it demonstrates lower morbidity and mortality compared with sigmoidectomy.

Hemidouble Stapling Technique versus Ghosting Double Stapling Technique for Esophagojejunostomy after Laparoscopic Total Gastrectomy.

The hemidouble stapler technique (HDST) in laparoscopic intracorporeal esophagojejunostomy has aspects that pose risks to the safety of the anastomosis. We developed a new esophagojejunostomy technique that converts a double-stapled anastomosis to a single-stapled anastomosis in laparoscopic total gastrectomy (LTG). The aim of this study is to compare the results of two techniques. Patients who underwent LTG for gastric cancer in our hospital between October 2016 and May 2022 were included in the study. Patients were retrospectively reviewed in two groups: those who underwent HDST and the ghosting double stapling technique (GDST). Both groups were analysed in terms of demographics, perioperative findings, and postoperative outcomes. The GDST was used in 14 patients. The HDST was used on 16 patients. Two patients in the HDST group whose esophagojejunal anastomosis was not assessed on endoscopic imaging were excluded. The mean total operative times were 292.6 ± 43.7 and 224.3 ± 36.1 min (p < 0.001). The mean times for esophagojejunostomy were 38.6 ± 4.3 and 26.8 ± 6.4 min (p < 0.001). One case of anastomotic stenosis was observed in the HDST group. Anastomotic leakage was not observed in both groups. However, there was no significant difference in overall morbidity between the groups (p > 0.05). Both HDST and GDST can be safely performed in the esophagojejunostomy for LTG.

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database.

Over 25% of patients diagnosed with colorectal cancer (CRC) will develop colorectal liver metastases (CRLM). Controversy exists over the surgical management of these patients. This study aims to investigate the safety of a simultaneous surgical approach by stratifying patients based on procedure risk and operative approach. Using ACS-NSQIP (2016-2020), patients with CRC who underwent isolated colorectal, isolated hepatic, or simultaneous resections were identified. Colorectal and hepatic procedures were stratified by morbidity risk (high vs. low) and operative approach (open vs. minimally invasive). Thirty-day overall morbidity was compared between risk matched isolated and simultaneous resection groups. A total of 65 417 patients were identified, with 1550 (2.4%) undergoing simultaneous resections. A total of 1207 (77.9%) underwent a low-risk colorectal and low-risk liver resection. On multivariate analysis, there was no significant difference in overall morbidity between patients who had a simultaneous open high-risk colorectal/low-risk hepatic procedure compared to patients who had an isolated open high-risk colorectal procedure (odds ratio: 1.19; 95% confidence interval: 0.94-1.50; p = 0.148). All other combinations of simultaneous procedures had statistically significant higher rates of morbidity than the isolated group. Simultaneous resection of colorectal and synchronous CRLM is associated with an increased risk of morbidity in most circumstances in a risk stratified analysis, although rates of readmission and reoperation were not increased. Minimally invasive surgical approaches may significantly mitigate this morbidity.

Sequential transcatheter arterial chemoembolization and portal vein embolization before hepatectomy for the management of patients with hepatocellular carcinoma: a systematic review and meta-analysis.

R0 resection is the gold standard for the treatment of hepatocellular carcinoma. However, residual liver deficiency remains a major obstacle to hepatectomy. This article aims to explore the short-term and long-term efficacy of preoperative sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) in the treatment of hepatocellular carcinoma. Multiple electronic literature databases up to February 2022 were searched. Furthermore, clinical studies comparing sequential TACE + PVE with portal vein embolization (PVE) were included. The outcomes included hepatectomy rate, overall survival, disease-free survival, overall morbidity, mortality, posthepatectomy liver failure, the percentage increase in FLR. Five studies included 242 patients who received sequential TACE + PVE and 169 patients received PVE. The sequential TACE + PVE group demonstrated more favorable results in terms of hepatectomy rate (OR = 2.37; 95% CI 1.09-5.11; P = 0.03), overall survival (HR 0.55; 95% CI 0.38 to - 0.79; P = 0.001), disease-free survival (HR 0.61; 95% CI 0.44-0.83; P = 0.002), and percentage increase in FLR (MD = 4.16%; 95% CI 1.13-7.19; P = 0.007). The pooled results did not demonstrate significant differences in overall morbidity, mortality, and posthepatectomy liver failure between the sequential TACE + PVE and PVE groups. Preoperative sequential TACE + PVE has been shown to be a safe and feasible treatment for hepatocellular carcinoma to improve resectability, and it has been shown to provide better long-term oncological outcomes than PVE.

Effects of ketorolac on complications and postoperative pancreatic fistula in patients undergoing pancreatectomy

BackgroundThere are conflicting data on the risk of postoperative pancreatic fistula (POPF) associated with postoperative NSAID use. The primary objective of this multi-center retrospective study was to assess the relationship between ketorolac use and POPF. The secondary objective was to assess for effect of ketorolac use on overall complication rate. MethodsRetrospective chart review of patients undergoing pancreatectomy from January 1, 2005–January 1, 2016 was performed. Data on patient factors (age, sex, comorbidities, previous surgical history etc.), operative factors (surgical procedure, estimated blood loss, pathology etc.), and outcomes (morbidities, mortality, readmission, POPF) were collected. The cohort was compared based on ketorolac use. ResultsThe study included 464 patients. Ninety-eight (21%) patients received ketorolac during the study period. Ninety-six (21%) patients were diagnosed with POPF within 30 days. There was a significant association between ketorolac use and clinically relevant POPF (21.4 vs. 12.7%) (p = 0.04, 95% CI [1.76, 1.04–2.97]). There was no significant difference in overall morbidity or mortality between the groups. DiscussionThough there was no overall increase in morbidity, there was a significant association between POPF and ketorolac use. The use of ketorolac after pancreatectomy should be judicious.

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience.

Obesity is a major public health problem and a well-known cause of multiple comorbidities. With the increasing application of minimally invasive surgery for benign and malignant liver lesions, the results of laparoscopic liver resection (LLR) in obese patients are of great interest. To evaluate the short-term operative outcomes after LLR in obese patients and compare them to patients with normal weight and overweight. All 235 consecutive patients undergoing LLR from 2008 to 2023 were retrospectively analysed. Patients were categorized into 3 groups based on their body mass index (BMI): normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). The groups were then compared regarding preoperative data and intra- and postoperative outcomes. Despite higher ASA score and associated comorbidities in the obese group, there were no significant differences in intraoperative complication (blood loss, damage to surrounding structures, conversion rate) between BMI groups (20.8% vs. 16.8% vs. 22.7%, p = 0.619). There were no significant differences in overall morbidity (34.7% vs. 27.7% vs. 29.5%, p = 0.582), as well as major morbidity (15.9% vs. 11.8% vs. 11.4%, p = 0.784) or mortality rates (1.4% vs. 1.7% vs. 0.0%, p = 1.000). Univariate logistic regression did not show BMI or obesity as a predictive variable for intraoperative complication. Obesity is not a significant, strong risk factor for worse short-term outcomes, and LLR may be considered also in patients with overweight and obesity.

Impact of Early Enteral Nutrition on Delayed Gastric Emptying and Nutritional Status After Pancreaticoduodenectomy.

Although early enteral nutrition (EEN) is an accepted practice after pancreaticoduodenectomy (PD), the impact of EEN on postoperative complications or nutritional status remains unclear. We aimed to investigate the impact of EEN on delayed gastric emptying (DGE) and nutritional status after PD. A total of 143 patients underwent PD between January 2012 and September 2020. We excluded patients who underwent a two-stage pancreatojejunostomy, in whom the enteral tube was accidentally pulled out, or with insufficient information in their medical records. The incidence of postoperative complications was compared between patients who received EEN (EEN group, n = 21) and those who did not (control group, n = 21) after propensity score matching. Univariate and multivariate analyses were performed to identify the risk factors affecting the incidence of these complications. Nutritional status was assessed at postoperative months 1, 3, and 6. The incidence of grade B/C DGE in the EEN group was significantly lower than that in the control group (4.8% vs. 28.6%, p = 0.03). There was no significant difference in overall morbidity, incidence of any other postoperative complications, or all-grade DGE. In multivariate analysis, EEN was associated with a reduction in the incidence of grade B/C DGE (p < 0.01). In the analysis of nutritional status, EEN was significantly associated with better nutritional status at postoperative month 1. EEN can lead to a lower clinically relevant DGE rate and better nutritional status in the early postoperative period in patients undergoing PD.

Is age just a number or does it really affect the surgical and oncological outcomes after pancreatoduodenectomy?

To review the impact of age on perioperative and postoperative outcomes in patients following pancreaticoduodenectomy. The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2014 to December 2018 of all patients who underwent pancreatoduodenectomy. Postoperative morbidity and oncological outcomes were compared between patients aged ≤60 years in group A and those aged >60 years in group B. Data was analysed using SPSS 20. Of the 161 patients, 103(64%) were males and 58(36%) were females. There were 117(73%) patients in group A; 72(61.5%) males and 45(38.5%) females with an overall mean age of 46±11 years. The remaining 44(27%) were in group B; 31(70.5%) males and 13(29.5%) females with an overall mean age of 67±05 years. The most common pathology was adenocarcinoma 130(81%), commonest site was periampullary 85(53%) and the most common pancreatic reconstruction technique employed was pancreaticogastrostomy 110(68%). Patients in group B had significantly higher comorbidities compared to those in group A (p<0.05). Estimated blood loss during surgery was significantly higher in group B (p=0.004). There was no significant difference in overall morbidity (p=0.856), reoperation (p=1.000), 30-day readmission rate (p=0.097), 90-day mortality rate (p=0.324)) and overall survival (p=0.551) between the groups. Pancreatoduodenectomy could be performed in the elderly with comparable morbidity and oncological outcomes as younger patients. Comorbid conditions remained higher in elderly patients and preoperative optimisation may help improve postoperative outcomes.

The Comprehensive Complication Index (CCI) for improved reporting of complications in endourological stone treatment.

The Clavien-Dindo Classification (CDC) lacks a combined score of multiple complications in one patient. The comprehensive complication index (CCI) circumvents this problem making it a valuable instrument to optimize quality control. We aimed to introduce and validate CCI in the treatment of urolithiasis. 60day postoperative complications of 327 consecutive patients undergoing percutaneous nephrolitholapaxy (PNL) and ureterorenoscopy (URS) between 2017 and 2019 were retrospectively assessed and graded according to CDC. CCI was calculated for each patient. Overall morbidity scores of CCI and CDC were compared. Correlation analyses between the two scores and length of hospital stay (LOS) were performed. A multivariate analysis was performed to identify predictive factors for complications. Sample size calculation for an imaginary clinical trial was compared between CCI and CDC. A significant difference in overall morbidity between CCI and CDC was revealed for PNL (p < 0.001) and URS (p = 0.001). There was no statistically significant difference in comparing correlations between cumulative CCI and LOS versus non-cumulative CDC and LOS for both cohorts. Operating time > 90min, maximum stone size, positive preoperative urine culture and PNL type (p < 0.001) were predictive factors for postoperative complications in PNL, while urine culture (p = 0.02) was for URS. Sample size calculation based on CCI resulted in a significant reduction of required patients for PNL (- 48%) and URS (- 84%) compared to CDC. CCI could successfully be validated in endourological stone treatment with the advantage of assessing complications in their entirety compared to CDC. CCI can significantly reduce the required sample size in future clinical trials.

Intracorporeal vs extracorporeal anastomosis following neoplastic right hemicolectomy resection: a systematic review and meta-analysis of randomized control trials.

While minimally invasive surgery is the preferred approach for right hemicolectomy, the choice of anastomotic technique is still debated. Both intracorporeal (ICA) and extracorporeal anastomosis (ECA) are described, with conflicting reports on safety and efficacy seen. This study aimed to examine impact of ICA and ECA on outcomes in right hemicolectomy. A meta-analysis of randomized control trials (RCT) was performed. The primary outcome was overall morbidity. The secondary outcomes included both perioperative and post-operative outcomes. Four RCTs were included incorporating 399 patients (199 patients (49.9%) ICA Vs 200 (50.1%) ECA). There was no significant difference in overall morbidity (RR 0.79, 95% CI 0.43, 1.48, p = 0.47), anastomotic leak (RR 1.34, 95% CI 0.58, 3.13, p = 0.5) or surgical site infections (RR 0.53, 95% CI 0.17, 1.64, p = 0.27). ICA patients had a significantly less post-operative ileus (RR 0.53, 95% CI 0.3-0.94, p = 0.03) quicker return to first flatus (WMD - 0.71, 95% CI - 1.12, 0.31, p = 0.0005), first bowel motion (WMD - 0.53, 95% CI - 0.69, - 0.37, p < 0.00001) and first meal (WMD - 0.68, 95% CI - 1.33, - 0.03, p = 0.04). Pain scores were significantly better for ICA patients on POD 3 (WMD - 0.76, 95% CI - 1.23, - 0.28, p = 0.002), POD 4 (WMD - 0.90, 95% CI - 1.71, - 0.09, p = 0.03) and POD 5 (WMD - 0.67, 95% CI - 1.22, - 0.13, p = 0.01). Length of hospital stay was similar (WMD - 0.46, 95% CI - 1.14, 0.22, p = 0.19). ICA is associated with a quicker return to normal physiological function with equivalent post-operative morbidity. Both ECA and ICA are safe and feasible for restoring normal bowel continuity.

Evaluation of the use of component separation in elderly patients: results of a large cohort study with 30-day follow-up.

The incidence of massive ventral hernias among the elderly will increase as the population ages. Advanced age is often viewed as a contraindication to elective hernia repair. A relationship between age and complications of component separation procedures for ventral hernias is not well established. This study evaluated the effect of age on the peri-operative safety of AWR. The 2005-2013 ACS-NSQIP participant use data were reviewed to compare surgical site infection (SSI), overall morbidity, and serious morbidity in non-emergent component separation procedures among all age groups. All patients were stratified into four age quartiles and evaluated. Baseline characteristics included age, body mass index (BMI) and ASA 3 or 4 criteria. Statistical analysis was performed using SPSS. Odds ratios (OR) and 95% confidence intervals were reported as appropriate. 4485 patients were identified. Majority of the cases were clean (76.8%). Patients were divided into the following quartiles based on age. The older quartile had a mean age of 72.7 ± 4.87years. There were baseline differences in BMI and chronic comorbidity severity (measured by incidence of ASA score of 3 or 4) between the age groups, with the oldest group having lower BMI but higher rate of ASA 3 or 4 (p < 0.0001 for both). The rate of postoperative SSI was significantly different between age quartile groups (ranging from 16.3% from the youngest group to 9.4% for the oldest group, p < 0.0001). After adjusting for other baseline differences, advanced age was independently associated with lower SSI rate (OR 0.55, 95% CI 0.41-0.73). There was no significant difference in overall morbidity (p = 0.277) and serious morbidity (p = 0.131) between groups. AWR is being performed with safety across all age groups. In selected patients of advanced age, AWR can be performed with similar safety profile and low SSI rate.

Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS-NSQIP follow up analysis.

Calls for multivisceral resection (MVR) of retroperitoneal sarcoma (RPS) are increasing, although the risks and benefits remain controversial. We sought to analyze current 30-day morbidity and mortality rates, and trends in utilization of MVR in a national database. Overall morbidity, severe morbidity, mortality rates, and temporal trends were analyzed utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). From 2012 to 2015, a total of 564 patients underwent RPS resection with 233 patients (41%) undergoing MVR. The MVR group had a higher rate of preoperative weight loss and larger tumors overall. When comparing MVR to non-MVR, there was no significant difference in overall morbidity (22% vs 17%, P = .13), severe morbidity (11% vs 8%, P = .18), or mortality (<1% vs 2%, P = .25). On multivariate analysis, MVR was not associated with increased overall morbidity or severe morbidity. Mortality rates were too low for meaningful statistical analysis. Annual rates of MVR ranged from 37% to 46% with no significant change over time (P = .47). Short-term morbidity and mortality rates after MVR for RPS remain acceptable, but rates of MVR show little change over time in NSQIP hospitals. Concerns about increased morbidity and mortality should not be viewed as a contraindication to wider implementation of MVR for RPS.

The effect of HIV status on clinical outcomes of surgical sepsis in KwaZulu-Natal Province, South Africa.

KwaZulu-Natal Province, South Africa (SA), has long been the epicentre of the HIV epidemic, but the impact of HIV co-infection on the clinical outcomes of emergency surgical patients with sepsis remains largely unknown. To review our experience with the management of patients with HIV co-infection and to compare the disease spectrum and outcome with those without HIV infection. A retrospective study was undertaken at the Pietermaritzburg Metropolitan Surgical Service (PMSS), SA over a 5-year period from January 2010 to December 2014. A total of 675 patients with a documented surgical source of sepsis were reviewed. Of these, 332 (49%) were male, and the mean age was 46 (standard deviation 19) years. HIV status was known in 237 (35%) patients, 146 (62%) were HIV-positive and the remaining 91 (38%) were HIV-negative. Other than tuberculosis of the abdomen being significantly more common in HIV-positive than HIV-negative patients (10% v. 2%, p=0.033), there were no differences in the spectrum of diseases between the two groups. There were no significant differences in overall morbidity or mortality. When adjusted for CD4 counts, the mortality in HIV-positive patients with a CD4 count &lt;200 cells/μL was 60% (15/25) and in those with a CD4 count &gt;200 cells/μL it was 2% (2/101) (p&lt;0.001). The clinical presentation and the spectrum of surgical sepsis in patients with HIV co-infection were not markedly different to those in patients who were not HIV-infected. HIV-infected patients with a CD4 count &lt;200 cells/μL had a significantly higher mortality. Management approaches should not differ based solely on the HIV status of patients with surgical sepsis.

Perioperative complications of esophagectomy: Postneoadjuvant treatment versus primary surgery - Our experience and review of literature.

: To compare perioperative complications in esophagectomy after neoadjuvant therapy v/s primary surgery. : Retrospective analysis of perioperative complications in a prospectively maintained data base of patients who underwent esophagectomy as Primary surgery or after neoadjuvant therapy was done. : 238 cases of esophagectomies performed for esophageal carcinoma were analysed and compared, out of which 125(52.5%) were given neoadjuvant therapy followed by surgery and 113(47.5%) underwent primary surgery. Surgical procedure was standard for both the groups. All the cases were analysed for perioperative complications. : Data was analysed using Open Epi soft ware. Association between the two study group was assessed with Chi square test. : On comparison, both the groups were comparable in demographic profile and type of surgery performed. However, tumour stage was higher for cases who received neoadjuvant therapy as expected. On analysis there was no significant difference in overall morbidity and 30 days mortality. : Neoadjuvant Chemo/chemoradiotherapy is a feasible option in esophageal carcinoma without increase in incidence of peri operative morbidity or mortality.

Comparison of perioperative outcomes in endovascular versus open repair for juxtarenal and pararenal aortic aneurysms: A propensity-matched analysis

Objective Endoluminal aortic aneurysm repair is suitable within certain anatomic specifications. This study aims to compare 30-day outcomes of endovascular versus open repairs for juxtarenal and pararenal aortic aneurysms (JAA/PAAs). Methods The ACS-NSQIP database was queried from 2012 to 2015 for JAA/PAA repairs. Procedures characterized as emergent were included in the study; however, failed prior repairs and ruptured aneurysms were excluded. The preoperative and perioperative patient characteristics, operative techniques, and outcome variables were compared between the open aortic repair and the endovascular aortic repair groups. Propensity scoring was performed to clinically match open aortic repair and endovascular aortic repair groups on preoperative risk and select perioperative factors that differed significantly in the unmatched groups. Outcome comparisons were then performed between matched groups. Results A total of 1005 (789 JAAs and 216 PAAs) aneurysm repairs were included in the study. Of these, there were 395 endovascular aortic repairs and 610 open aortic repairs. Propensity scoring created a matched group of 263 endovascular aortic repair and 263 open aortic repair patients. There was no statistically significant difference in 30-day mortality rates between matched endovascular aortic repair and open aortic repair patients (2.7% vs. 5.7%). The endovascular aortic repair group had a shorter ICU length of stay and overall hospital stay. The 30-day morbidity significantly favored endovascular aortic repair over open aortic repair (16% vs. 35%, p < 0.001). The main drivers of morbidity for endovascular aortic repair versus open aortic repair included return to the OR (6.8% vs. 15%, p < 0.001), rate of cardiac or respiratory failure (7.6% vs. 21%, p = 0.001), rate of renal insufficiency or failure (3.8% vs. 9.9%, p = 0.009), and rate of pneumonia (1.5% vs. 6.8%, p = 0.004). Conclusions There is no difference in mortality rates between endovascular aortic repair versus open aortic repair when repairing JAAs/PAAs. There is a significant difference in overall morbidity, and ICU and hospital length of stay favoring endovascular aortic repair over open aortic repair. This supports the expanded applicability and efficacy of endovascular repair for complex aneurysms.

Postoperative outcomes following mechanical bowel preparation before proctectomy: a meta-analysis.

Previous meta-analyses of mechanical bowel preparation (MBP) before colorectal surgery have grouped colon and rectal resection together. An increased postoperative morbidity has been suggested in the absence of MBP following proctectomy. The current study used meta-analytical techniques to evaluate the comparative outcome of patients who received MBP prior to proctectomy. A comprehensive search was performed for published studies examining the effect of MBP before proctectomy on patient outcome. Random effects methods were used to combine data. Eleven studies including 1258 patients were identified. There was no significant difference in overall morbidity (OR 1.062, 95% CI 0.584-1.933, P = 0.844), anastomotic leakage (OR 1.144, 95% CI 0.767-1.708, P = 0.509), surgical site infection (OR 0.946, 95% CI 0.549-1.498, P = 0.812) or mortality (OR 1.377, 95% CI 0.549-3.455, P = 0.495) between those who did not and those who did receive MBP prior to proctectomy. The current study did not demonstrate a beneficial effect of MBP prior to proctectomy, but the data were limited. Decision-making as to its use should be made on a case-by-case basis.

Video-Assisted versus Open Lobectomy in Patients with Compromised Lung Function: A Literature Review and Meta-Analysis.

BackgroundIt has been suggested that video-assisted (VATS) lobectomy is safer than open lobectomy in patients with compromised lung function, but data regarding this are limited. We assessed acute outcomes of VATS compared to open lobectomy in these high-risk patients using a systematic literature review and meta-analysis of data.MethodsThe databases PubMed and Scopus were searched for studies published between 2000 and 2013 that reported mortality and morbidity of VATS in high-risk lung cancer patients defined as having compromised pulmonary or cardiopulmonary function. Study selection, data collection and critical assessment of the included studies were performed according to the recommendations of the Cochrane Collaboration.ResultsThree case-control studies and three case series that included 330 VATS and 257 open patients were identified for inclusion. Operative mortality, overall morbidity and pulmonary morbidity were 2.5%, 39.3%, 26.2% in VATS patients and 7.8%, 57.5%, 45.5% in open lobectomy group, respectively. VATS lobectomy patients experienced significantly lower pulmonary morbidity (RR = 0.45; 95% CI, 0.30 to 0.67; p = 0.0001), somewhat reduced operative mortality (RR = 0.51; 95% CI, 0.24 to 1.06; p = 0.07), but no significant difference in overall morbidity (RR = 0.68; 95% CI, 0.41 to 1.14; p = 0.14).ConclusionThe existing data suggest that VATS lobectomy is associated with lower risk for pulmonary morbidity compared with open lobectomy in lung cancer patients with compromised lung function.

Effect of Pregnancy on Adverse Outcomes After General Surgery.

The literature regarding the occurrence of adverse outcomes following nonobstetric surgery in pregnant compared with nonpregnant women has conflicting findings. Those differing conclusions may be the result of inadequate adjustment for differences between pregnant and nonpregnant women. It remains unclear whether pregnancy is a risk factor for postoperative morbidity and mortality of the woman after general surgery. To compare the risk of postoperative complications in pregnant vs nonpregnant women undergoing similar general surgical procedures. In this retrospective cohort study, data were obtained from the American College of Surgeons' National Surgical Quality Improvement Program participant user file from January 1, 2006, to December 31, 2011. Propensity-matched females based on 63 preoperative characteristics were matched 1:1 with nonpregnant women undergoing the same operations by general surgeons. Operations performed between January 1, 2006, and December 31, 2011, were analyzed for postoperative adverse events occurring within 30 days of surgery. Rates of 30-day postoperative mortality, overall morbidity, and 21 individual postoperative complications were compared. The unmatched cohorts included 2764 pregnant women (50.5% underwent emergency surgery) and 516,705 nonpregnant women (13.2% underwent emergency surgery) undergoing general surgery. After propensity matching, there were no meaningful differences in all 63 preoperative characteristics between 2539 pregnant and 2539 nonpregnant patients (all standardized differences, <0.1). The 30-day mortality rates were similar (0.4% in pregnant women vs 0.3% in nonpregnant women; P = .82), and the rate of overall morbidity was also not significantly different between pregnant vs nonpregnant patients (6.6% vs 7.4%; P = .30). There was no significant difference in overall morbidity or 30-day mortality rates in pregnant and nonpregnant propensity-matched women undergoing similar general surgical operations. General surgery appears to be as safe for pregnant women as it is for nonpregnant women.

Meta-analysis of pancreaticogastrostomy versus pancreaticojejunostomy on occurrences of postoperative pancreatic fistula after pancreaticoduodenectomy

Pancreatic fistula (PF) is the most common and challenging complication after pancreaticoduodenectomy (PD). This meta-analysis aimed to evaluate the impact of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) on occurrences of postoperative PF. A systematic literature search in the Medline, EMBASE, OVID, and Cochrane databases was performed to identify all eligible randomized controlled trials (RCTs). Pooled estimates were presented with 95% confidence intervals (CI). Six RCTs involving 1005 patients met the inclusion criteria. The incidence of PF [odds ratio (OR) 0.58, 95% CI, 0.42-0.81; p=0.001], intra-abdominal abscess or collections (OR 0.43, 95% CI, 0.28-0.65; p<0.001), and biliary fistula (OR 0.28, 95% CI, 0.11-0.74; p=0.01) were found to be significantly lower in the PG group than in the PJ group. There was no significant difference in overall morbidity, other complications, hospital mortality, or length of hospital stay between the two groups. The meta-analysis showed that PG following PD represents a safe procedure associated with fewer PFs compared with PJ.

The Causes of Conversion from Laparoscopy to Laparotomy in Patients with Laparoscopic Repair of Perforated Peptic Ulcer

Purpose: Perforated peptic ulcer is an emergency condition. Laparoscopic ulcer repair is a feasible and safe procedure. The aim of this study was to research the efficacy of laparoscopic repair of peptic ulcer and to discuss the causes of conversion from laparoscopy to laparotomy. Methods: We collected 34 patients with perforated peptic ulcer underwent laparoscopic surgery from October 2003 to October 2008. Thirty four patients with perforated peptic ulcer underwent laparoscopic intervention and 6 cases were converted to laparotomy. The demographics, laboratory data, perioperative data, morbidity and mortality were compared. Results: In demographics of two groups, there were no significant differences in sex, age, location, and mean duration of symptoms of acute abdominal pain. However, there were significant differences in median size of perforation, mean duration of history of peptic ulcer related pain, and the experiences of surgeon. There were no significant differences in the laboratory data and perioperative data of two groups. In morbidity and mortality of two groups, there were no significant differences in leakage, wound infection, intra-abdominal abscess, ileus, urinary tract infection, pneumonia, and mortality, but there was significant difference in overall morbidity in two groups. Conclusions: Laparoscopic repair of perforated peptic ulcer is safe and could be used in routine clinical practice. However, patients with larger perforations (>10 mm), longer duration of history peptic ulcer related pain (>2 years), and learning curve of surgeon could be associated with conversion rate. It is associated with higher morbidity in patients with conversion from laparoscopy to laparotomy.