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Tayarer A, Tas EE, Senat A. Effects of abdominal, vaginal, and laparoscopic hysterectomies on total oxidant/antioxidant levels: A prospective observational study. Medicine (Baltimore) 2025; 104:e41380. [PMID: 39854753 PMCID: PMC11771671 DOI: 10.1097/md.0000000000041380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 01/08/2025] [Accepted: 01/10/2025] [Indexed: 01/26/2025] Open
Abstract
This prospective observational study aimed to compare abdominal hysterectomy (AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) in terms of oxidative stress (OS) by measuring serum levels of total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). Of the 3 groups, namely, AH, VH, and TLH, 22 patients were enrolled in each to investigate the aim of the study mentioned above. Patient demographics, clinical and surgical characteristics, and preoperative and postoperative (0th and 24th hours) serum TAS, TOS, and OSI levels were investigated. The groups differed significantly based on surgical indications (P < .001). While abnormal uterine bleeding was more prevalent in the AH (95.5%) and TLH (77.3%) groups, pelvic organ prolapse (POP) was more prevalent in the VH group (90.1%). The mean age and menopausal patient rates were significantly higher in the VH group than in the AH and TLH groups (P < .001). The groups did not differ significantly in terms of simultaneous bilateral salpingo-oophorectomy rates (P = .10). However, additional POP surgery was performed in 14 patients in the VH group. The mean operative time was significantly shorter in the AH group than in the VH and TLH groups (P = .001). The groups did not differ significantly based on either the preoperative or postoperative serum TAS levels (P > .05). Furthermore, the change in serum TAS levels over time was not significant in any of the groups (P > .05). In contrast, preoperative serum TOS and OSI levels were significantly higher in the VH group than in the AH and TLH groups (P < .05). The groups did not differ significantly in terms of serum TOS and OSI levels at 0th and 24th hours postoperatively (P > .05). Serum TOS and OSI levels increased dramatically over time in the AH and TLH groups (P < .05), but not in the VH group (P > .05). post hoc analysis showed that the changes in serum TOS and OSI values in the AH and TLH groups were between the preoperative and postoperative 0th hour levels (P < .001). Our results indicated that the total antioxidant capacity was preserved in all 3 techniques. However, VH causes less OS than the other hysterectomy techniques.
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Affiliation(s)
- Aybuke Tayarer
- Department of Obstetrics and Gynecology, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Emre Erdem Tas
- Department of Obstetrics and Gynecology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Almila Senat
- Department of Biochemistry, Republic of Turkey Ministry of Health Taksim Training and Research Hospital, İstanbul, Turkey
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2
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Gomes R, Costa-Pinho A, Ramalho-Vasconcelos F, Sousa-Pinto B, Santos-Sousa H, Resende F, Preto J, Lima-da-Costa E. Portomesenteric Venous Thrombosis after Bariatric Surgery: A Case Series and Systematic Review Comparing LSG and LRYGB. J Pers Med 2024; 14:722. [PMID: 39063976 PMCID: PMC11277930 DOI: 10.3390/jpm14070722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Portomesenteric Venous Thrombosis (PMVT) is a rare but serious complication of Metabolic Bariatric Surgery (MBS). Although more frequently reported after laparoscopic sleeve gastrectomy (LSG), the risk factors for PMVT remain unclear. This study aims to compare the incidence and determinants of PMVT between LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB). (2) Methods: A retrospective analysis of 5235 MBSs conducted at our institution between 2015 and 2023 identified five cases of PMVT. Additionally, a systematic review in March 2023, covering PubMed, Web of Science and Scopus, was performed. Several data were analyzed regarding risk factors. (3) Results: In our case series, the incidence of PMVT was 0.1%. The five cases described involved four females with a BMI between 39.7 and 56.0 kg/m2. Their comorbidities were associated with metabolic syndrome, all women used oral contraceptive and two patients were diagnosed with thrombophilia or pulmonary embolism. Per protocol, thromboprophylaxis was administered to all patients. Diagnosis was made at a median of 16 days post-surgery, with abdominal pain being the main presenting symptom. Acute cases were managed with enoxaparin, unfractionated heparin and fibrinolysis. One patient required surgery. Ten studies were included in the systematic review and 205 patients with PMVT were identified: 193 (94.1%) post-LSG and 12 post-LRYGB. The most common comorbidities were dyslipidemia, hypertension, diabetes, sleep apnea and liver disorders; (4) Conclusions: PMVT is a potentially life-threatening complication after MBS, requiring preventive measures, timely diagnosis and several treatments. Our findings suggest a higher occurrence in women with an elevated BMI and post-LSG. Tailored thromboprophylaxis for MBS patients at risk of PMVT may be warranted.
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Affiliation(s)
- Raquel Gomes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | | | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS—Centre for Health Technologies and Services Research, University of Porto, 4200-319 Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (R.G.)
- Obesity Integrated Responsibility Unit (CRI-O), São João Local Health Unit, 4200-319 Porto, Portugal
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Parlier M, Thomson CB, Rendahl A, Strelchik A, Baldo C, Eckman SK, Krueger A, Gordon-Evans WJ. Prospective, randomized, clinical trial on the effects of laparoscopic insufflation pressures on portal pressures in dogs. Vet Surg 2024; 53:613-619. [PMID: 38380543 DOI: 10.1111/vsu.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/30/2023] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE The adverse effects of intra-abdominal pressure from capnoperitoneum on cardiovascular and pulmonary systems have been well documented, but the effects on portal pressures in dogs with various insufflation pressures is poorly defined. The aim of the present study was to measure the effect of a range of insufflation pressures on the portal pressure, using direct pressure measurements in patients undergoing laparoscopy. STUDY DESIGN Clinical randomized prospective study. ANIMALS Nine client-owned dogs undergoing routine laparoscopy. METHODS Two rounds of direct portal pressure assessments were performed, at insufflation pressures of 0, 6, 10, and 14 mmHg in a predetermined randomized sequence. The data were analyzed for effects of insufflation pressure, hemodynamic alterations, and round. A best-fit exponential model of the relationship between portal pressure and insufflation pressure was created. RESULTS Portal pressure increased by 38% at 6 mmHg, 95% at 10 mmHg, and 175% at 14 mmHg compared to baseline. Portal pressure increased at an average rate of 7.45% per mmHg of insufflation pressure. Effects of weight, weight/insufflation pressure interaction, and round of insufflation were not statistically significant. No systemic hemodynamic adverse events were observed. CONCLUSION Portal pressure increased as insufflation pressure increased. There was no clinically significant difference in baseline portal pressure between rounds of insufflation. CLINICAL SIGNIFICANCE This exponential model of portal pressure supports the use of the minimum insufflation pressure to allow visualization during laparoscopy. The return of portal pressure to baseline following desufflation supports the comparison of portal pressure measurements before and after laparoscopic shunt attenuation.
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Affiliation(s)
- Mark Parlier
- Veterinary Specialty Hospital, San Diego, California, USA
| | - Christopher B Thomson
- Veterinary Specialty Hospital, San Diego, California, USA
- Ethos Discovery, San Diego, California, USA
| | - Aaron Rendahl
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Alena Strelchik
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Caroline Baldo
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Sarah K Eckman
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Amy Krueger
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
| | - Wanda J Gordon-Evans
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, Minnesota, USA
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4
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Na J, Chung YE, Jang IY, Lee YY, Kim TJ, Lee JW, Kim BG, Chang CS, Choi CH. Advantages of laparoscopy in gynecologic surgery in elderly patients. Obstet Gynecol Sci 2024; 67:243-252. [PMID: 38053014 PMCID: PMC10948208 DOI: 10.5468/ogs.23238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. METHODS We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. RESULTS Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar restuls were observed in cancer-only and benign-only cohorts. CONCLUSION Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.
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Affiliation(s)
- Jaewon Na
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Young Eun Chung
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Il-Yeo Jang
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Chi-Son Chang
- Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong,
Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
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Mazzinari G, Rovira L, Albers-Warlé KI, Warlé MC, Argente-Navarro P, Flor B, Diaz-Cambronero O. Underneath Images and Robots, Looking Deeper into the Pneumoperitoneum: A Narrative Review. J Clin Med 2024; 13:1080. [PMID: 38398395 PMCID: PMC10889570 DOI: 10.3390/jcm13041080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Laparoscopy offers numerous advantages over open procedures, minimizing trauma, reducing pain, accelerating recovery, and shortening hospital stays. Despite other technical advancements, pneumoperitoneum insufflation has received little attention, barely evolving since its inception. We explore the impact of pneumoperitoneum on patient outcomes and advocate for a minimally invasive approach that prioritizes peritoneal homeostasis. The nonlinear relationship between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV) is discussed, emphasizing IAP titration to balance physiological effects and surgical workspace. Maintaining IAP below 10 mmHg is generally recommended, but factors such as patient positioning and surgical complexity must be considered. The depth of neuromuscular blockade (NMB) is explored as another variable affecting laparoscopic conditions. While deep NMB appears favorable for surgical stillness, achieving a balance between IAP and NMB depth is crucial. Temperature and humidity management during pneumoperitoneum are crucial for patient safety and optical field quality. Despite the debate over the significance of temperature drop, humidification and the warming of insufflated gas offer benefits in peritoneal homeostasis and visual clarity. In conclusion, there is potential for a paradigm shift in pneumoperitoneum management, with dynamic IAP adjustments and careful control of insufflated gas temperature and humidity to preserve peritoneal homeostasis and improve patient outcomes in minimally invasive surgery.
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Affiliation(s)
- Guido Mazzinari
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
- Department of Anesthesiology, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
- Department of Statistics and Operational Research, University of Valencia, Calle Doctor Moliner 50, 46100 Burjassot, Spain
| | - Lucas Rovira
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, L’Olivereta, 46014 València, Spain; (L.R.); (B.F.)
| | - Kim I. Albers-Warlé
- Department of Colorectal Surgery, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain;
- Department of Anesthesiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Michiel C. Warlé
- Departments of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Pilar Argente-Navarro
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
| | - Blas Flor
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, L’Olivereta, 46014 València, Spain; (L.R.); (B.F.)
| | - Oscar Diaz-Cambronero
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
- Department of Anesthesiology, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
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6
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Xiao F, Qiu XF, You CW, Xie FP, Cai YY. Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy. World J Gastrointest Surg 2023; 15:859-870. [PMID: 37342845 PMCID: PMC10277945 DOI: 10.4240/wjgs.v15.i5.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/11/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Previously, some studies have proposed that total laparoscopic gastrectomy (TLG) is superior to laparoscopic-assisted gastrectomy (LAG) in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications. However, there are still few studies on the changes in postoperative liver function in patients undergoing LG. The present study compared the postoperative liver function of patients with TLG and LAG, aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.
AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.
METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center (including the Department of Gastrointestinal Surgery and the Department of General Surgery) of Zhongshan Hospital affiliated with Xiamen University, including 40 patients who underwent TLG and 40 patients who underwent LAG. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltransferase (GGLT), total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL), and other liver function-related test indices were compared between the 2 groups before surgery and on the 1st, 3rd, and 5th d after surgery.
RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation. The levels of ALT and AST in the TLG group were within the normal range, while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group (P < 0.05). The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range (P < 0.05). The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2, the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4, and the TBIL, DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7 (P < 0.05). No significant difference was observed at other time points (P > 0.05).
CONCLUSION Both TLG and LAG can affect liver function, but the effect of LAG is more serious. The influence of both surgical approaches on liver function is transient and reversible. Although TLG is more difficult to perform, it may be a better choice for patients with gastric cancer combined with liver insufficiency.
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Affiliation(s)
- Fan Xiao
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Xing-Feng Qiu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Cai-Wen You
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Fu-Ping Xie
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Yao-Yuan Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou 350000, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
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Godoroja-Diarto D, Copaescu C, Rusu E, Constantin A. The Role of Thromboprophylaxis in Patients with Portal Vein Thrombosis: A Life-Threatening Complication after Laparoscopic Sleeve Gastrectomy Following 8 Years of Experience in a Bariatric Center of Excellence. Diagnostics (Basel) 2022; 13:diagnostics13010043. [PMID: 36611335 PMCID: PMC9818164 DOI: 10.3390/diagnostics13010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Porto-mesenteric vein thrombosis (PVMT) is a rare but life-threatening complication after laparoscopic sleeve gastrectomy (LSG). Laparoscopic sleeve gastrectomy (LSG) is considered the most common procedure for efficiently realizing weight loss and treating obesity-related co-morbidities. This study aimed to shed light on this relatively rare complication by presenting a series of patients who developed PMVT after LSG in light of the need to change the specific protocol of thromboprophylaxis in bariatric patients. We proposed to answer two questions: whether we should perform a thrombophilia workup as a standard practice and whether we should extend chemoprophylaxis to more than 3 weeks among all bariatric patients. This study also aimed to investigate the possible risk factors and eventually present our updated protocol for PMVT management and prophylaxis.
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Affiliation(s)
- Daniela Godoroja-Diarto
- Department Anaesthesia and Intennsive Care, Ponderas Academic Hospital, 014142 Bucharest, Romania
- Correspondence: (D.G.-D.); (E.R.); Tel.: +40-756026125 (D.G.-D.); Tel.: +40-745036782 (E.R.)
| | - Catalin Copaescu
- Department of Surgery, Ponderas Academic Hospital, 014142 Bucharest, Romania
| | - Elena Rusu
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
- Correspondence: (D.G.-D.); (E.R.); Tel.: +40-756026125 (D.G.-D.); Tel.: +40-745036782 (E.R.)
| | - Alina Constantin
- Department Gastroenterology, Ponderas Academic Hospital, 014142 Bucharest, Romania
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8
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Kwak MH, Lee MW, Ko SE, Rhim H, Kang TW, Song KD, Kim JM, Choi GS. Laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for subphrenic hepatocellular carcinoma. Ultrasonography 2022; 41:543-552. [PMID: 35430787 PMCID: PMC9262669 DOI: 10.14366/usg.21241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/09/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Radiofrequency ablation is a curative treatment option for very early-stage or earlystage hepatocellular carcinoma (HCC). However, percutaneous radiofrequency ablation (PRFA) for subphrenic tumors is technically challenging. Laparoscopic radiofrequency ablation (LRFA) has been used to overcome this disadvantage. This study compared the treatment outcomes between LRFA and PRFA for subphrenic HCC. METHODS This retrospective study screened patients who underwent PRFA or LRFA for subphrenic HCC between 2013 and 2018. Therapeutic outcomes, including local tumor progression (LTP), intrahepatic distant recurrence (IDR), extrahepatic metastasis (EM), disease-free survival (DFS), and overall survival (OS), were compared between the two groups. RESULTS Thirty patients in the PRFA group and 23 patients in the LRFA group were included. LTP was observed in six patients in the PRFA group (20%), but in no patients in the LRFA group. The cumulative LTP rates at 1, 3, and 5 years were 3.7%, 23.4%, and 23.4%, respectively, in the PRFA group and 0.0% in the LRFA group (P=0.015). The IDR, EM, and DFS rates were not significantly different between the two groups (P=0.304, P=0.175, and P=0.075, respectively). The OS rates at 1, 3, and 5 years were 96.6%, 85.7%, and 71.6%, respectively, in the PRFA group and 100%, 95.7%, and 95.7%, respectively, in the LRFA group (P=0.049). CONCLUSION LRFA demonstrated better therapeutic outcomes than did PRFA for subphrenic tumors in terms of LTP and OS. Therefore, LRFA can be considered as the first-line treatment option for subphrenic HCC.
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Affiliation(s)
- Min Hwan Kwak
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Seong Eun Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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9
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Ypsilantis P, Lambropoulou M, Anagnostopoulos K, Kiroplastis K, Tepelopoulos G, Bangeas P, Ypsilantou I, Pitiakoudis M. Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat. Surgery 2021; 171:973-979. [PMID: 34876288 DOI: 10.1016/j.surg.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Major liver resection may compromise gut-barrier function, increasing the risk of postoperative infectious complications. The aim of the present experimental study was to compare the effect of the laparoscopic versus the open technique for major liver resection on integrity as well as inflammatory and immune responses of the gut barrier. METHODS Wistar rats were subjected to open 70% hepatectomy (group H), laparoscopic 70% hepatectomy (group LH), sham operation (group S) or no intervention (group C). At various timepoints (1 hour-1 week) after operation, ileal tissue was excised for oxidative state assessment (TBARS levels), histopathologic examination, histomorphometric analysis, immunohistochemical assessment of the mitotic and apoptotic activity, and tissue expression of inflammatory (interleukin-6, tumor necrosis factor-α, nuclear factor-κB and vascular cell adhesion molecule-1) and immune response biomarkers (CD4+ and CD8+ T-lymphocytes) of the intestinal mucosa. RESULTS No changes were noted in oxidative state. The histopathologic profile was less deteriorated in group LH compared to group H. Intestinal mucosa atrophy was less intense in group LH compared to group H and was related to an equally compromised crypt cell mitotic activity. Tissue overexpression of interleukin-6, tumor necrosis factor-α, nuclear factor-κΒ, vascular cell adhesion molecule-1, CD4+, and CD8+ T-lymphocytes was less pronounced in group LH compared to group H. CONCLUSION The employment of the laparoscopic technique for major liver resection in the rat attenuated disruption of the gut barrier compared to the open procedure. This was related to less pronounced inflammatory and immune responses of the intestinal mucosa.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Lambropoulou
- Laboratory of Histology and Embryology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Konstantinos Kiroplastis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Tepelopoulos
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Petros Bangeas
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ifigenia Ypsilantou
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Research and Surgical Research, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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10
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Perova-Sharonova VM, Albokrinov AA, Fesenko UA, Gutor TG. Effect of intraabdominal hypertension on splanchnic blood flow in children with appendicular peritonitis. J Anaesthesiol Clin Pharmacol 2021; 37:360-365. [PMID: 34759544 PMCID: PMC8562451 DOI: 10.4103/joacp.joacp_293_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/29/2019] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Intraabdominal hypertension (IAH) is poorly diagnosed condition that cause splanchnic hypoperfusion and abdominal organs ischemia and can lead to multiple organ failure. There are no scientific data regarding effect of intraabdominal pressure (IAP) on splanchnic circulation in children. Material and Methods: Ninety-four children after surgery for appendicular peritonitis were enrolled in the study. After IAP measurement children were included in one of two groups according IAP levels: “without IAH” (n = 51) and “with IAH” (n = 43). Superior mesenteric artery (SMA) and portal vein (PV) blood flows (BFSMA, BFPV, mL/min) were measured, and SMA and PV blood flow indexes (BFISMA, BFIPV, ml/min*m2) and abdominal perfusion pressure (APP) were calculated in both groups. Results: Median BFISMA and BFIPV in group “with IAH” were lower by 54.38% (P < 0.01) and 63.11% (P < 0.01) respectively compared to group “without IAH”. There were strong significant negative correlation between IAP and BFISMA (rs = –0.66; P < 0.0001), weak significant negative correlation between IAP and BFIPV (rs = –0.36; P = 0.0001) in group “with IAH” and weak significant negative correlation between IAP and BFISMA (rs = –0.30; P = 0.0047) in group “without IAH”. There were no statistically significant correlations between IAP and BFIPV in group “without IAH”, between BFISMA and APP in both groups and between BFIPV and APP in both groups. Conclusion: Elevated IAP significantly reduces splanchnic blood flow in children with appendicular peritonitis. BFISMA and BFIPV negatively correlate with IAP in these patients. There is no correlation between BFISMA/BFIPV and APP in children with IAH due to appendicular peritonitis.
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Affiliation(s)
- Valentyna M Perova-Sharonova
- Lviv Regional Children's Clinic Hospital, Lysenka Str. 31, Lviv, Ukraine.,Danylo Halytsky Lviv National Medical University, Pekarska Str. 69, Lviv, Ukraine
| | | | - Ulbolhan A Fesenko
- Danylo Halytsky Lviv National Medical University, Pekarska Str. 69, Lviv, Ukraine
| | - Taras G Gutor
- Danylo Halytsky Lviv National Medical University, Pekarska Str. 69, Lviv, Ukraine
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11
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Inderbitzin DT, Mueller TU, Marti G, Eichenberger S, Fellay B, Magnin JL, Kraehenbuehl L. Severe portal and systemic acidosis during CO 2-laparoscopy compared to helium or gasless laparoscopy and laparotomy in a rodent model: an experimental study. Surg Endosc 2021; 36:4701-4711. [PMID: 34741205 PMCID: PMC9160112 DOI: 10.1007/s00464-021-08810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS This experimental study assesses the influence of different gases and insufflation pressures on the portal, central-venous and peripheral-arterial pH during experimental laparoscopy. METHODS Firstly, 36 male WAG/Rij rats were randomized into six groups (n = 6) spontaneously breathing during anaesthesia: laparoscopy using carbon dioxide or helium at 6 and 12 mmHg, gasless laparoscopy and laparotomy. 45 and 90 min after setup, blood was sampled from the portal vein, vena cava and the common femoral artery with immediate blood gas analysis. Secondly, 12 animals were mechanically ventilated at physiological arterial pH during 90 min of laparotomy (n = 6) or carbon dioxide laparoscopy at 12 mmHg (n = 6) with respective blood gas analyses. RESULTS Over time, in spontaneously breathing rats, carbon dioxide laparoscopy caused significant insufflation pressure-dependent portal acidosis (pH at 6 mmHg, 6.99 [6.95-7.04] at 45 min and 6.95 [6.94-6.96] at 90 min, pH at 12 mmHg, 6.89 [6.82-6.90] at 45 min and 6.84 [6.81-6.87] at 90 min; p < 0.05) compared to laparotomy (portal pH 7.29 [7.23-7.30] at 45 min and 7.29 [7.20-7.30] at 90 min; p > 0.05). Central-venous and peripheral-arterial acidosis was significant but less severely reduced during carbon dioxide laparoscopy. Laparotomy, helium laparoscopy and gasless laparoscopy showed no comparable acidosis in all vessels. Portal and central-venous acidosis during carbon dioxide laparoscopy at 12 mmHg was not reversible by mechanical hyperventilation maintaining a physiological arterial pH (pH portal 6.85 [6.84-6.90] (p = 0.004), central-venous 6.93 [6.90-6.99] (p = 0.004), peripheral-arterial 7.29 [7.29-7.31] (p = 0.220) at 90 min; Wilcoxon-Mann-Whitney test). CONCLUSION Carbon dioxide laparoscopy led to insufflation pressure-dependent severe portal and less severe central-venous acidosis not reversible by mechanical hyperventilation.
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Affiliation(s)
- Devdas T Inderbitzin
- Department of Cardiac Surgery, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Department of Anatomy, Faculty of Science and Medicine, University of Fribourg, 1700, Fribourg, Switzerland.
| | - Tobias U Mueller
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Grischa Marti
- Department of Anatomy, Faculty of Science and Medicine, University of Fribourg, 1700, Fribourg, Switzerland.,Department of Internal Medicine, Hospital of Langenthal, 4900, Langenthal, Switzerland
| | - Simone Eichenberger
- Department of Anatomy, Faculty of Science and Medicine, University of Fribourg, 1700, Fribourg, Switzerland
| | - Benoît Fellay
- Department of Haematology and Clinical Chemistry, Hôpital Fribourgeois HFR, 1708, Fribourg, Switzerland
| | - Jean-Luc Magnin
- Department of Haematology and Clinical Chemistry, Hôpital Fribourgeois HFR, 1708, Fribourg, Switzerland
| | - Lukas Kraehenbuehl
- Department of Surgery, Bauchzentrum Medical Center See-Spital, Gruetstrasse 55, 8802, Kilchberg, Zurich, Switzerland
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12
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Bickel A, Khatib S, Kakiashvilli E, Palzur E. Reappraisal of ischemia-reperfusion injury in a short duration laparoscopic surgery, a pilot study. BMC Surg 2021; 21:346. [PMID: 34544418 PMCID: PMC8451121 DOI: 10.1186/s12893-021-01339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Serum biochemical changes during laparoscopic surgery and positive pressure pneumoperitoneum (PP) may reflect mild oxidative stress due to the ischemia-reperfusion (I/R) mechanism. However, there is still a controversy regarding the exact mechanism of PP in creating oxidative stress and whether the induction of PP causes I/R effects at all. To elucidate this debated issue, we studied, for the first time, the changes of I/R parameters in the serum, in a pilot study, during laparoscopic cholecystectomy using a reliable, independent exogenous oxidative biomarker, together with common intrinsic biomarkers of oxidative stress. Patients and methods Our study included 20 patients scheduled for elective laparoscopic cholecystectomy. We evaluated the levels of the extrinsic and endogenous markers for oxidative stress during awareness, under anesthesia, the end of surgery (abdominal CO2 evacuation), and 2 h afterward. Results After an initial increase in oxidative stress following anesthesia, we did not notice any further significant rise in the levels of the synthetic exogenous and the endogenous biomarkers at the end of the surgery and 2 h later on. However, a positive correlation was noted between the levels of both the intrinsic and extrinsic markers. Conclusions In our study, the capability of the extrinsic biomarker to detect mild oxidative stress was not validated. Our study stresses the heterogeneous nature of the oxidative reactions and the diversity of the endogenous and exogenous biomarkers while detecting various biochemical patterns under mild oxidative stress, during the short period of laparoscopic surgery.
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Affiliation(s)
- Amitai Bickel
- Department of Surgery A, Galilee Medical Center, P.O.Box 21, 22100, Nahariya, Israel. .,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Soliman Khatib
- Department of Biochemistry, MIGAL Galilee Research Institute, Kiryat Shmona, Israel
| | - Eli Kakiashvilli
- Department of Surgery A, Galilee Medical Center, P.O.Box 21, 22100, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eilam Palzur
- Eliachar Research Laboratories, Galilee Medical Center, Nahariya, Israel
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13
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Aydin C, Akkoc A, Aydin ZB. How safe and effective is stentless laparoscopic ureterolithotomy in elderly patients? Int J Clin Pract 2021; 75:e14308. [PMID: 33928719 DOI: 10.1111/ijcp.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE With the improvement of minimally invasive urology procedures, open surgical interventions are less common to treat ureteral calculus. Laparoscopic ureterolithotomy (LU) indications are large multiple and/or impacted ureteral calculus that may not be treated with shock-wave lithotripsy or ureterorenoscopy approaches. The aim of our study was to investigate the feasibility and safety of stentless LU in elderly patients. METHODS Between October 2011 and December 2019, 38 geriatric patients underwent stentless transperitoneal LU for upper/mid ureteral calculi. The transperitoneal route was applied in all patients by two surgeons. No double J stent inserted in any patient. The data of all patients reviewed retrospectively. RESULTS The average age was 64.60 ± 3.70 years. The mean calculi size was 19.42 ± 1.41 mm. Ten patients had unsuccessful shock wave lithotripsy or ureterorenoscopy history. The calculi-free rate was 100%. Clavien grade 1 complications were seen in 11 (28.9%) cases. No major perioperative and postoperative complications were encountered. The average length of hospital stay was 3.24 ± 1.53 days. CONCLUSION The significant advances in medical technology and healthcare, lead a rising number of geriatric patients to take benefit of even complicated surgery. Although laparoscopy and its safety in the geriatric population pursues a challenge and the assessment of this procedure is hence obligatory, we think that stentless LU is safe, economical and less uncomfortable for elderly patients.
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Affiliation(s)
- Cemil Aydin
- Department of Urology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
| | - Ali Akkoc
- Department of Urology, Alaaddin Keykubat University School of Medicine, Training and Research Hospital, Alanya, Turkey
| | - Zeynep Banu Aydin
- Department of Radiology, Hitit University School of Medicine, Training and Research Hospital, Corum, Turkey
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14
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Feldman ZM, Wang LJ, Chou EL, Latz CA, Sumpio BJ, Eagleton MJ, Conrad MF. Venous mesenteric ischemia carries high procedural burden and elevated mortality in patients with severe presentation. J Vasc Surg Venous Lymphat Disord 2021; 9:1479-1487. [PMID: 33741519 DOI: 10.1016/j.jvsv.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Venous mesenteric ischemia (VMI) presents with variable severity resulting in a spectrum of outcomes. This study sought to characterize the natural history of VMI and identify drivers of intervention and adverse outcomes. METHODS All patients who presented to our institution with acute and subacute VMI between 1993 and 2016 were identified. Images were reviewed to determine thrombosis location and charts were reviewed to identify clinical factors and outcomes. Univariate analysis was performed for demographics, comorbidities, and presenting characteristics, with primary outcomes of intervention, readmission, and 30-day mortality. A survival analysis was performed with log-rank difference testing for demographics, comorbidities, and presenting characteristics. RESULTS We identified 103 patients with acute and subacute VMI. The locations of the thrombosis included the superior mesenteric vein (SMV) (31.1%); SMV and portal vein (35.9%); SMV, portal, and splenic veins (15.5%); and other combinations of portomesenteric veins (17.4%), without correlation between the location and outcomes. Most patients were male (60.6%), 22.3% were actively smoking, and the median Charlson comorbidity score was 4 (interquartile range, 2-7). The mean patient age was 61.3 years. More than one-half had a known hypercoagulability (52.4%), 22.3% had prior bowel resection, and 8.7% had prior mesenteric venous intervention, including transjugular intrahepatic portosystemic shunt procedures. Thirty-five patients underwent 83 procedures during their hospitalization, and 23 patients underwent surgical intervention specifically. Prior mesenteric venous procedure, abdominal tenderness, and lactatemia of more than 1.5 mmol/L were associated with an increased need for surgical intervention (P < .05). Patients with leukocytosis of greater than 10K/μL had increased surgical intervention (P = .10), although without statistical significance. However, symptoms for less than 2 weeks (P < .05) were associated with decreased surgical intervention. The 30-day mortality was low in this cohort (6.8%), but was increased in patients requiring intervention (11.4%). For those undergoing procedures, a shorter time to intervention was associated with an improved 30-day mortality (8.7% for procedures on hospital days 0-1 vs 16.7% for hospital day 2 or later; P = .01). Abdominal tenderness and lactatemia were associated with increased 30-day mortality (6.8% vs 3.6% [P < .01] and 16.0% vs 3.8% [P = .03], respectively). A Kaplan-Meier survival analysis revealed a median survival of 7.1 years, with a 1-year survival rate of 74.9%, a 3-year survival rate of 67.1%, and a 5-year survival rate of 57.9%. Negative predictors of survival included a higher Charlson comorbidity index (hazard ratio, 3.7; P < .01) and malignancy (hazard ratio, 3.1; P < .01). CONCLUSIONS The 30-day mortality of VMT is low, but more than one-third of patients required an intervention beyond anticoagulation. Comorbidity, a prior mesenteric vessel or intestinal operation, and presentation with tenderness or relevant laboratory abnormalities portend worse outcomes. Early intervention is associated with improved outcomes.
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Affiliation(s)
- Zach M Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | | | - Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
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15
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Early Effects of Laparoscopic Sleeve Gastrectomy and Laparoscopic One-Anastomosis Gastric Bypass on Portal Venous Flow: a Prospective Cohort Study. Obes Surg 2021; 31:2410-2418. [PMID: 33660156 DOI: 10.1007/s11695-021-05267-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is an infrequent, yet potentially lethal, complication of bariatric surgery. The aim of this prospective, non-randomized, cohort study is to compare between laparoscopic sleeve gastrectomy (LSG) and laparoscopic one-anastomosis gastric bypass (LOAGB) in terms of their early postoperative effects on portal venous flow and patency. METHODS Forty-nine morbidly obese patients were allocated to one of 2 groups (A or B). Group A patients underwent LSG, whereas group B patients underwent LOAGB. Portal venous Doppler ultrasound scanning was performed preoperatively and 2 weeks postoperatively in all cases, in order to assess the portal venous flow (PVF) in terms of flow direction and peak systolic velocity (PSV); as well as to assess the portal venous patency and exclude PVT. The mean change in PSV (ΔPSV) and the mean percentage change in PSV (%ΔPSV) were determined in both groups. RESULTS In all cases (group A (n = 26); group B (n = 23)), the direction of PVF was "hepatopetal" both preoperatively and 2 weeks postoperatively. The mean ΔPSV and the mean %ΔPSV were higher in LSG patients "group A" (- 0.84 cm/s and 3.25% respectively) compared with LOAGB patients "group B"(- 0.06 cm/s and 0.27% respectively); P = 0.038 and 0.039 respectively. The mean change in PSV was in the negative direction in both groups, i.e., "deceleration." No cases of PVT were reported in the study. CONCLUSIONS Laparoscopic sleeve gastrectomy is associated with greater reduction in portal venous peak systolic flow velocity in the early postoperative period, compared with laparoscopic one-anastomosis gastric bypass.
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16
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Ashraf Butt AU, Sajjad A, Malik AR, Farooq A, Ali Q, Rizvi ZA, Khan MS, Anwar M. Changes in Hematological Parameters and Liver Enzymes During Laparoscopic Cholecystectomy. Cureus 2021; 13:e13098. [PMID: 33728120 PMCID: PMC7934604 DOI: 10.7759/cureus.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Changes in hematological parameters, such as neutrophils, leukocytes, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume, have been observed during laparoscopic surgeries. Objectives The objectives of this research were to assess the changes in hematological parameters and liver enzymes during laparoscopic cholecystectomy (LC). Methods This prospective observational study included patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Patients with comorbidities, including hepatitis, diabetes, and where laparoscopic cholecystectomy was converted to open cholecystectomy, were excluded. Preoperative and postoperative baseline hematological parameters and liver function tests (LFTs) were recorded. Characteristics like age, gender, body mass index (BMI), indication for surgery, duration of surgery, the pressure of pneumoperitoneum, and the duration of hospital stay were noted. A paired sample t-test was applied to assess the difference between the mean pre and postoperative values of different hematological parameters. Results It was observed that hemoglobin (Hb), hematocrit (Hct), platelets, and alkaline phosphatase (ALP) decreased postoperatively. However, mean corpuscular volume (MCV), mean platelet volume (MPV), leukocytes, and alanine transaminase (ALT) increased postoperatively. The difference in mean Hb, MCV, Hct, leukocytes, MPV, and ALT was statistically significant (p<0.05). Conclusion There were significant changes in the levels of hematological parameters and liver enzymes during LC.
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Affiliation(s)
| | - Ahsan Sajjad
- Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Ahmad Farooq
- Medicine, Government Rural Dispensary, Rawalpindi, PAK
| | - Qasim Ali
- General Surgery, Holy Family Hospital, Rawalpindi, PAK
- Surgery, Holy Family Hospital, Rawalpindi, PAK
| | - Zuhair Ali Rizvi
- Intensive Care Unit, Shifa International Hospital, Islamabad, PAK
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17
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Kaya Uğur B, Pirbudak L, Öztürk E, Balat Ö, Uğur MG. Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study. Turk J Obstet Gynecol 2020; 17:186-195. [PMID: 33072423 PMCID: PMC7538827 DOI: 10.4274/tjod.galenos.2020.28928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023] Open
Abstract
Objective: To compare spinal anesthesia (SA) with general anesthesia (GA) in gynecologic laparoscopic surgery regarding anesthetic parameters and patient satisfaction together with an assessment of total oxidant, antioxidant levels, and Oxidative Stress index (OSI). Materials and Methods: Sixty patients who were planned to undergo gynecologic laparoscopy were randomized into group G (GA) and group S (SA). Demographics, adverse events and anesthetic parameters were recorded before induction, after induction, and at the 5th, 10th, 15th, 30th, 60th, 90th, and 120th minutes. Patients and surgeons completed questionnaires. Total antioxidant capacity (TAC), total oxidant level (TOL), and OSI were measured. Results: There was no difference between the groups in terms of hemodynamic parameters except heart rate at 30th minute and mean arteral pressure at 10th, 15th, 30th, and 60th minute (p<0.05). The postoperative arterial blood pH value was lower in group S (p=0.021). Intraoperative hypotension was lower in group S (p=0.038). There was more intraoperative hypotension in group S when compared with group G (p=0.038). Postoperative analgesic consumption was higher and onset of postoperative pain was shorter in group G (p=0.001 for both). There was no difference between the groups in terms of patient and surgeon satisfaction. There was no difference in terms of TAC, TOL, and OSI between the groups (p=0.862, p=0.940, and p=0.728, respectively). Conclusion: SA may become a reliable alternative to GA in gynecologic laparoscopy when hemodynamic and respiratory parameters, patient and surgeon satisfaction, as well as total oxidant, antioxidant levels, and OSI are considered.
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Affiliation(s)
- Berna Kaya Uğur
- Gaziantep University Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Lütfiye Pirbudak
- Gaziantep University Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey
| | - Ebru Öztürk
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Özcan Balat
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Gaziantep University Faculty of Medicine, Department of Obstetrics and Gynecology, Gaziantep, Turkey
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18
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An Analysis of Free-hand Targeting in Laparoscopic Liver Microwave Ablation. Surg Laparosc Endosc Percutan Tech 2020; 31:215-219. [PMID: 33048898 DOI: 10.1097/sle.0000000000000868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, new technologies have been developed for antenna placement in laparoscopic liver tumor ablation (LLTA). At this point, it is important to analyze the efficacy of free-hand targeting to identify deficiencies and opportunities for improvement. METHODS This was an institutional review board-approved retrospective study. Video recordings of 30 consecutive patients with 77 lesions who underwent LLTA were reviewed. Tumor-specific anatomic and targeting-related parameters were analyzed using χ2, t test, and regression analyses. RESULTS Neuroendocrine metastasis was the dominant tumor type, with median tumor size 1.4 cm (range, 0.5 to 5.2). In total, 41 (53%) tumors were superficial and 36 (47%) deep. In 68 lesions (88%), an optimal targeting was achieved with first attempt, without a need for repositioning; whereas 9 lesions (12%) required repositioning of antenna. For 37% (15/41) of superficial and 56% (20/36) of deep lesions, a straight avascular needle trajectory was not present, requiring steering of the antenna around vascular and biliary structures. All procedures were completed laparoscopically without bleeding or biliary complications. Local treatment recurrence rate in follow-up was 10% (n=8). CONCLUSIONS This study shows that in experienced hands, LLTA through free-hand technique is safe and efficacious, providing an accurate targeting with the first pass in 90% of tumors. Although newer technology is being developed to guide less-experienced surgeons in needle targeting, it should be kept in mind that a straight trajectory is not available for 1/3 of superficial and half of deep lesions. Hence, ablation surgeons need to develop free-hand skills to avoid possible hemorrhagic and biliary complications in LLTA.
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19
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Luketina R, Luketina TLH, Antoniou SA, Köhler G, Könneker S, Manzenreiter L, Wundsam H, Koch OO, Knauer M, Emmanuel K. Prospective randomized controlled trial on comparison of standard CO 2 pressure pneumoperitoneum insufflator versus AirSeal®. Surg Endosc 2020; 35:3670-3678. [PMID: 32767145 PMCID: PMC7412773 DOI: 10.1007/s00464-020-07846-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
Background AirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO2 recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO2 insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgical outcomes between AirSeal® and standard CO2 insufflators in patients undergoing the most frequently performed laparoscopic procedures. Methods One hundred and ninety-eight patients undergoing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair were randomized to either AirSeal® (group A) or standard pressure CO2 insufflator (group S). The primary endpoints were operative time and level of postoperative shoulder tip pain (Visual Analog Scale). Secondary outcomes included Clavien–Dindo grade complications, surgical side effect and length of hospital stay. Results Patients were randomized to either group A (n = 101) or group S (n = 97) and were analyzed by intention-to-treat. There was no significant difference in mean operative time between the groups (median [IQR]; 71 min [56–94] in group A vs. 69 min [52–93] in group S; p = 0.434). Shoulder tip pain levels were significantly lower in group S (VAS 0 [0–3] in group S vs. 2 [0–4] in group A; p = 0.001). There was no significant difference in complications, surgical side effects (subcutaneous emphysema was not observed in any group) and length of hospital stay. Conclusion This randomized controlled trial showed that using the AirSeal® system did not reduce operative time and was associated with a higher postoperative shoulder tip pain compared to standard CO2 insufflator for short elective surgeries. ClinicalTrials.gov (NCT01740011).
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Affiliation(s)
- Rosalia Luketina
- Department Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany.
| | - Theodore L H Luketina
- Department of Anaesthesia & Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Stavros A Antoniou
- Department of Surgery, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Gernot Köhler
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Ordensklinikum Linz, Austria
| | - Sören Könneker
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hanover, Germany
| | - Lisa Manzenreiter
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Helwig Wundsam
- Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity), Ordensklinikum Linz, Austria
| | - Oliver Owen Koch
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Michael Knauer
- Breast Center Ostschweiz, Schuppistrasse 10, 9016, St. Gallen, Switzerland
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
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20
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Della Corte A, Ratti F, Monfardini L, Marra P, Gusmini S, Salvioni M, Venturini M, Cipriani F, Aldrighetti L, De Cobelli F. Comparison between percutaneous and laparoscopic microwave ablation of hepatocellular carcinoma. Int J Hyperthermia 2020; 37:542-548. [DOI: 10.1080/02656736.2020.1769869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Francesca Ratti
- Division of Hepatobiliary Surgery, Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Paolo Marra
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | - Simone Gusmini
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | - Marco Salvioni
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - Federica Cipriani
- Division of Hepatobiliary Surgery, Ospedale San Raffaele, Milan, Italy
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, Ospedale San Raffaele, Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
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Kabakchiev CM, Zur Linden AR, Singh A, Beaufrère HH. Effects of intra-abdominal pressure on laparoscopic working space in domestic rabbits ( Oryctolagus cuniculus). Am J Vet Res 2020; 81:77-83. [PMID: 31887092 DOI: 10.2460/ajvr.81.1.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effects of 3 intra-abdominal pressures (IAPs) on pneumoperitoneal (laparoscopic working space) volume in domestic rabbits (Oryctolagus cuniculus). ANIMALS 6 female New Zealand White rabbits. PROCEDURES A Latin-square design was used to randomly allocate sequences of 3 IAPs (4, 8, and 12 mm Hg) to each rabbit in a crossover study. Rabbits were anesthetized, subumbilical cannulae were placed, and CT scans were performed to obtain baseline measurements. Each IAP was achieved with CO2 insufflation and maintained for ≥ 15 minutes; CT scans were performed with rabbits in dorsal, left lateral oblique, and right lateral oblique recumbency. The abdomen was desufflated for 5 minutes between treatments (the 3 IAPs). Pneumoperitoneal volumes were calculated from CT measurements with 3-D medical imaging software. Mixed linear regression models evaluated effects of IAP, rabbit position, and treatment order on working space volume. RESULTS Mean working space volume at an IAP of 8 mm Hg was significantly greater (a 19% increase) than that at 4 mm Hg, and was significantly greater (a 6.9% increase) at 12 mm Hg than that at 8 mm Hg. Treatment order, but not rabbit position, also had a significant effect on working space. Minor adverse effects reported in other species were observed in some rabbits. CONCLUSIONS AND CLINICAL RELEVANCE A nonlinear increase in abdominal working space was observed with increasing IAP. Depending on the type of procedure and visual access requirements, IAPs > 8 mm Hg may not provide a clinically important benefit for laparoscopy in rabbits.
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Ribeiro MS, Zorron RPAS, Silva SJQ, Cadena SMR, Antunes F, Santos Junior MBD, Mello LM, Igreja Junior HJS, Batista VL, Scheffer JP, Oliveira ALA. New technique of intragastric sleeve: viability and survival in a pig model. AN ACAD BRAS CIENC 2020; 90:3075-3080. [PMID: 30304235 DOI: 10.1590/0001-3765201820180199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/21/2018] [Indexed: 01/22/2023] Open
Abstract
Developing a less invasive, practical and cost-effective operative technique for obesity treatment represents a pressing need for our society. In this way, intragastric single port sleeve by endoplication was tested in six pigs during 18 weeks. Celiotomy was performed with animal placed in dorsal decubitus position. Single port gastrostomy was performed and double tobacco pouch sutures were made in fundic region, making a gastric sleeve. At the end, stomach layers and skin were closed in a conventional manner. Means and the standard deviations of surgical time were calculated. The procedure was simple and all animals survived; there were no significant blood loss and no intra and postoperative complications. The procedure was fast (67.4 minutes). The technique has the advantage of not requiring the use of mechanical sutures, making it less costly. The innovation of this procedure was the use of a single port gastrostomy device to perform an intraluminal sleeve. What made this technique less invasive were the use of a single port, nonmanipulation of the stomach intra-abdominally, ease of execution and no need of pneumoperitoneum. The new technique is acceptable and has reproducible viability, had a short procedure time without intra and postoperative complications.
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Affiliation(s)
- Mariana S Ribeiro
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Ricardo P A S Zorron
- Department of Surgery, Division of Innovative Surgery, Klinikum Bremerhaven Reinkenheide, Postbrookstraße 103, 27574, Bremerhaven, Germany.,Department of Surgery, Hospital Municipal Miguel Couto, R. Mario Ribeiro, 117, Leblon, 22430-160 Rio de Janeiro, RJ, Brazil
| | - Saulo José Q Silva
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Silvia M R Cadena
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Fernanda Antunes
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Marcelo B Dos Santos Junior
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Luciana M Mello
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Haroldo José S Igreja Junior
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Vilson L Batista
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - Jussara P Scheffer
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
| | - André L A Oliveira
- Laboratory of Animal Medicine and Surgery, State University of Northern Rio de Janeiro, Av. Alberto Lamego, 2000, Parque Califórnia, 28035-200 Campos dos Goitacazes, RJ, Brazil
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Mazahreh TS, Aleshawi AJ, Al-Zoubi NA, Altabari M, Aljarrah Q. Comparison of postoperative liver function between different dissection techniques during laparoscopic cholecystectomy. Future Sci OA 2020; 6:FSO462. [PMID: 32257375 PMCID: PMC7117547 DOI: 10.2144/fsoa-2019-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: In this study, we investigated and compared the effect of different types of dissector (Maryland vs Hook) on changes in liver function tests (LFTs) after laparoscopic cholecystectomy. Patients & methods: The enrolled patients were divided into two groups. Group A patients underwent dissection by Maryland dissecting forceps, group B by Hook dissecting instrument. LFTs were measured preoperatively and at 1 day and 1 week, postoperatively. Results: For both Maryland and Hook dissection, the 1-day postoperative values for total bilirubin, alanine aminotransferase and aspartate aminotransferase were significantly higher than the preoperative values. Also, there were no statistical differences between Hook and Maryland. Conclusion: The elevation of LFTs seems to be attributed to other factors. Laparoscopic cholecystectomy (LC) is an alternative to laparotomy and has become the standard treatment of benign gallbladder diseases. However, it has been noted that (following LC) the serum level of certain liver function tests (LFT) raises markedly in patients who had preoperatively normal LFT. Pneumoperitoneum is the main contributing factor. This is the first study to evaluate the effect of different dissectors on alteration of LFTs after LC. As there were no statistical differences in the variation of LFTs between the Maryland and Hook, it seems that the dissector type has no effect on the alteration of LFTs.
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Affiliation(s)
- Tagleb S Mazahreh
- Department of General Surgery & Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Abdelwahab J Aleshawi
- King Abdullah University Hospital, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nabil A Al-Zoubi
- Department of General Surgery & Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mohammad Altabari
- Department of General Surgery & Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Qusai Aljarrah
- Department of General Surgery & Urology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
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Kim MJ, Kim DW, Cho JY, Son IT, Kang SI, Oh HK, Kang SB. Postoperative Portomesenteric Venous Thrombosis After Colorectal Cancer Surgery. J Gastrointest Surg 2020; 24:396-404. [PMID: 30671797 DOI: 10.1007/s11605-018-04085-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Portomesenteric venous thrombosis (PMVT) can occur after colorectal surgery. Most previous studies included patients with various diseases, especially inflammatory bowel disease. The prevalence and clinical significance of PMVT developing after surgery for colorectal cancer (CRC) remain unclear. METHODS Consecutive patients who underwent resection for CRC between June 2003 and April 2016 were retrospectively analyzed. Postoperative PMVT was diagnosed based on pre- and postoperative computed tomography (CT). RESULTS Postoperative PMVT developed in 10 (0.24%) of 4232 patients who underwent resection for CRC. One patient had alcoholic liver cirrhosis, whereas nine did not have prior or current liver disease. PMVT in eight patients was detected within 2 weeks after surgery by CT, performed to evaluate non-specific symptoms such as mild fever and abdominal pain, or performed postoperatively after deep pelvic dissection. PMVT in the remaining two asymptomatic patients was diagnosed following surveillance CT 3 and 7 months after surgery, respectively. PMVT in the patient with liver cirrhosis was detected 13 days after surgery and found to involve the main portal vein, causing hyperbilirubinemia and requiring emergency thrombectomy with thrombolysis. PMVT in the nine patients without liver disease was resolved by anticoagulation therapy or conservative care without long-term complications. CONCLUSION PMVT after CRC surgery is likely an early postoperative event in most patients. The incidence of clinically significant PMVT in patients with CRC may be lower than previously reported. CT was reliable in the diagnosis and follow-up of these patients. Most patients with PMVT can be managed conservatively without serious long-term morbidity.
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Affiliation(s)
- Myung Jo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Il Tae Son
- Department of Surgery, Uijeongbu St. Mary's Hospital, Catholic University, Uijeongbu, South Korea
| | - Sung Il Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Veres T, Petrovics L, Sárvári K, Vereczkei A, Jancsó G, Farkas KB, Takács I. The effect of laparoscopic pre- and postconditioning on pneumoperitoneum induced injury of the peritoneum. Clin Hemorheol Microcirc 2020; 73:565-577. [PMID: 31156145 DOI: 10.3233/ch-190572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T.Gy. Veres
- Department of Surgical Research and Techniques, University of Pécs, Medical School, Pécs, Hungary
| | - L. Petrovics
- Department of Surgical Research and Techniques, University of Pécs, Medical School, Pécs, Hungary
| | - K. Sárvári
- Department of Surgical Research and Techniques, University of Pécs, Medical School, Pécs, Hungary
| | - A. Vereczkei
- Surgery Clinic University of Pécs, Medical School, Pécs, Hungary
| | - G. Jancsó
- Department of Surgical Research and Techniques, University of Pécs, Medical School, Pécs, Hungary
| | - K. Borbásné Farkas
- Institute of Bioanalysis, University of Pécs, Medical School, Pécs, Hungary
| | - I. Takács
- Department of Surgical Research and Techniques, University of Pécs, Medical School, Pécs, Hungary
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Cillo U, Bertacco A, Fasolo E, Carandina R, Vitale A, Zanus G, Gringeri E, D'Amico F, Bassi D, Neri D, Dadduzio V, Farinati F, Aliberti C. Videolaparoscopic microwave ablation in patients with HCC at a European high-volume center: Results of 815 procedures. J Surg Oncol 2019; 120:956-965. [PMID: 31373009 DOI: 10.1002/jso.25651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Videolaparoscopic (VL) microwave ablation (MWA) is not included in most of the international guidelines as a therapeutic option for hepatocellular carcinoma (HCC). Aim of this study was to assess the safety of VL MWA in patients with HCC for whom resection or percutaneous ablation is unsuitable. METHODS A retrospective analysis was performed on a prospective database of patients with HCC treated with VL MWA at our institution from 2009 to 2016. Patient demographics, operational characteristics, and complications were recorded. Statistical analysis was performed to identify safety profile, overall survival and recurrence rate. RESULTS A total of 815 VL MWA were performed in 674 patients with a mean age of 64 years. Patients had a mean Model for End-stage Liver Disease score of 10 (±3); 32.8% were Child B, 44.1% Barcelona Clinic Liver Cancer B-C. Perioperative mortality was 0.4%. Overall morbidity was 30.8%, with Dindo-Clavien complications ≥3 in 2%. The median length of stay was 2 days. In 43.1% VL MWA was the first-line therapy. Overall 1-, 3-, and 5-year survival rates were 81.9%, 54.9%, and 35.9%. CONCLUSIONS The present is the largest series of VL ablation and the bigger number of patients with HCC treated with MW reported nowadays. It confirms the safety of a minimally invasive procedure for patients with HCC when resection or percutaneous ablation is not feasible.
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Affiliation(s)
- Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Alessandra Bertacco
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Elisa Fasolo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | | | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Giacomo Zanus
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Enrico Gringeri
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Francesco D'Amico
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Domenico Bassi
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Daniele Neri
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplant Unit, Padua University, Padua, Italy
| | - Vincenzo Dadduzio
- Department of Clinical and Experimental Oncology, Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, Padua University, Padua, Italy
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Bani Hani MN, Al Manasra ARA, Obeidat F, Al-Omari MH, Bani Hani F. Portomesenteric Venous Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Do Energy Systems Pose as Instigating Factor to This Infrequent Complication? CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619843503. [PMID: 31040733 PMCID: PMC6482649 DOI: 10.1177/1179547619843503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/15/2022]
Abstract
Background Portomesenteric venous thrombosis (PMVT), a rare complication after laparoscopic sleeve gastrectomy (LSG). Severe consequences are owed to a high risk of bowel ischemia. Our aim is to present a series of patients who developed PMVT after LSG, highlighting the potential role of the vessel sealer and divider as a risk factor. Methods Medical records of seven patients who underwent LSG and developed PMVT from April 2010 to January 2019, at King Abdullah University Hospital and Jordan University Hospital, Jordan were reviewed. Our findings were studied, audited, and compared with published data. Results A sum of 4900 patients underwent LSG, 7 (0.14%) developed PMVT. The mean age and body mass index (BMI) were 36.8 years and 45 kg/m2, respectively. Four were women. Epigastric pain radiating to the back was the presenting symptom at a median time of 9 days after surgery. Computed tomography (CT) of the abdomen confirmed the diagnosis. Five patients presented with a total portal vein thrombosis (PVT), one with splenic vein thrombosis and one with dual portal and mesenteric vein thrombosis. Conclusion Portomesenteric venous thrombosis is a relatively uncommon complication following LSG. Early recognition is required to avoid catastrophic outcomes. The role of energy systems in the development of PMVT remains unknown and requires further elaboration.
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Affiliation(s)
- Mohammed N Bani Hani
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel Rahman A Al Manasra
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas Obeidat
- Department of Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Mamoon H Al-Omari
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Farah Bani Hani
- Student of Medicine and Surgery, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Effects of propofol on the inflammatory response during robot-assisted laparoscopic radical prostatectomy: a prospective randomized controlled study. Sci Rep 2019; 9:5242. [PMID: 30918320 PMCID: PMC6437140 DOI: 10.1038/s41598-019-41708-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALRP) is a minimally invasive procedure; however, some amount of surgical trauma that can trigger systemic inflammation remains. Moreover, pneumoperitoneum during RALRP induces ischemia–reperfusion injury (IRI). Propofol, an anesthetic, is known to have anti-inflammatory and antioxidant properties. In the present study, we compared the effects of propofol with those of desflurane on inflammation and IRI during RALRP via measurements of different biomarkers and evaluation of perioperative renal function. Fifty patients were randomized to receive either desflurane (n = 25) or propofol (n = 25) with remifentanil during RALRP. Serum levels of interleukin (IL)-6 (IL-6), tumor necrosis factor alpha, C-reactive protein, and nitric oxide were measured 10 min after anesthesia induction (T1), 100 min after carbon dioxide (CO2) insufflation (T2), and 10 min after CO2 deflation (T3). Perioperative urine outputs and the serum creatinine level at 24 h after surgery were also recorded. We found that IL-6 levels at T2 and T3 were higher than those at T1 in both groups, although the increases were significant attenuated only in the propofol group. The other parameters showed no differences among the three time points in both groups. The intraoperative urine output was significantly higher in the propofol group than in the desflurane group, while the creatinine level showed no significant changes in either group. Our findings suggest that propofol can not only attenuate the inflammatory response during and after pneumoperitoneum in patients undergoing RALRP but also prevent oliguria during pneumoperitoneum.
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Ozcan ATD, Doger C, Ozturk L, Yungul A, Kurtsahin M, Neselioglu S, Ergin M, But A. Comparison of the Effects of Sevoflurane and Desflurane on Thiol-Disulfide Homeostasis in Patients Undergoing Laparoscopic Cholecystectomy. Eurasian J Med 2019; 51:70-74. [PMID: 30911261 DOI: 10.5152/eurasianjmed.2019.18299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective This study aims to compare the effects of different inhalation anesthetics on oxidative status by measuring thiol-disulfide homeostasis in laparoscopic cholecystectomy surgeries. The effect of inhaler agents on thiol-disulfide homeostasis that shows the oxidative status in laparoscopic cholecystectomy is unknown. Materials and Methods In this study, 71 patients planned to undergo laparoscopic cholecystectomy under general anesthesia were included. They were divided into two groups: desflurane (group D, n: 35) and sevoflurane (group S, n: 36). Blood samples were taken before induction (T1), at 30th minute of insufflation (T2) (30th min of ischemia), and at 30th min postdeflation (T3) (30th min of reperfusion). The native thiols (-SH) and total thiols (-SH+ -SS) were determined. The amounts of disulfide (-SS), disulfide/native thiol percent ratios (-SS/-SH), disulfide/total thiol percent ratios (-SS/-SH+-SS), and native thiol/total thiol percent ratios (-SH/-SH+ -SS) were calculated. Results In the sevoflurane group, preoperative values and intraoperative 30th-minute SS-SH ratio were significantly reduced (p=0.017). In the desflurane group, intraoperative native thiol values and postdeflation levels significantly decreased compared to those in the preoperative values (p<0.001). Conclusion We think that the usage of sevoflurane was more protective in terms of the oxidative damage occurring during laparoscopic surgery.
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Affiliation(s)
- Ayca Tuba Dumanlı Ozcan
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Cihan Doger
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Levent Ozturk
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Aysun Yungul
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Muge Kurtsahin
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Salim Neselioglu
- Department of Biochemistry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Merve Ergin
- Department of Biochemistry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Abdulkadir But
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University School of Medicine, Ankara, Turkey
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The role of MDCT study to assess postoperative acute complications of laparoscopic sleeve gastrectomy (LSG). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Veres TG, Takács I, Nagy T, Jancsó G, Kondor A, Pótó L, Vereczkei A. Pneumoperitoneum induced ischemia-reperfusion injury of the peritoneum - Preconditioning may reduce the negative side-effects caused by carbon-dioxide pneumoperitoneum - Pilot study. Clin Hemorheol Microcirc 2018; 69:481-488. [PMID: 29660910 DOI: 10.3233/ch-170336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Laparoscopy is more beneficial than the conventional open technique, however the pneumoperitoneum created may have an ischemic side effect. OBJECTIVE Our aim was to evaluate the protective effects of preconditioning during laparoscopic cholecystectomies (LC). METHODS 30 patients were randomized into 2 groups: I. PreC (preconditioning: 5 min. inflation, 5 min. deflation, followed by conventional LC), II: LC (conventional LC). Blood samples were taken before hospitalization (C = control), before surgery, after anaesthesia (B.S.), after surgery (A.S.) and 24 hours after the procedure (24 h). Measured parameters were: malondialdehyde (MDA), reduced glutathione (GSH), sulfhydril groups (-SH), superoxide-dismutase (SOD), catalase (CAT), myeloperoxidase (MPO), length of hospitalization and pain (VAS = visual analogue scale). RESULTS Compared to the BS levels, no significant changes were detected in SOD's activity and MDA levels. GSH concentrations were significantly increased in the PreC group after operation. SH-, MPO, CAT and liver function enzymes were not significantly different. Hospitalization was shorter in the PreC group. Based on the VAS score patients had less pain in the PreC group. CONCLUSION Significant differences concerning PreC group were found in GSH values. In the PreC group pain decreased by 2-2.5 units following the procedure, 24 h after surgery, and hospitalisation was also significantly shorter. In our pilot study the potential protective effect of preconditioning could be defined.
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Affiliation(s)
| | - Ildikó Takács
- Department of Surgical Research and Techniques, University of Pécs, Hungary
| | - Tibor Nagy
- Department of Surgical Research and Techniques, University of Pécs, Hungary
| | - Gábor Jancsó
- Department of Surgical Research and Techniques, University of Pécs, Hungary
| | | | - László Pótó
- Institute of Bioanalysis, University of Pécs, Hungary
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Akyol I. Re: Global minimally invasive pyeloplasty study in children: Results from the pediatric urology expert group of the European association of urology young academic urologists working party. J Pediatr Urol 2018; 14:205. [PMID: 29559275 DOI: 10.1016/j.jpurol.2017.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ilker Akyol
- Nisa Hospital, Department of Urology, Istanbul, Turkey.
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Dupont S, Schiffer ERC, White MJ, Diaper JRA, Licker MJ, Masouyé PC. Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery. Gastroenterol Res Pract 2018; 2018:8063097. [PMID: 29721013 PMCID: PMC5867686 DOI: 10.1155/2018/8063097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. METHODS In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman's two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. RESULTS During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25-75), decreased from 23 (20-30) %/min to 18 (12.5-19) %/min (p < 0.001). Despite a generous crystalloid infusion rate (27 (22-35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p < 0.001) and reversed to baseline values post HIPEC. CONCLUSION Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP.
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Atraumatic Liver Retraction Using Nelaton Catheters During Totally Laparoscopic Gastrectomy. Surg Laparosc Endosc Percutan Tech 2017; 27:485-490. [PMID: 29189660 DOI: 10.1097/sle.0000000000000489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study introduces a novel technique for liver retraction during laparoscopic gastrectomy and assesses its impact on postoperative recovery. This study included 139 patients in whom Nelaton catheters (n=57) or Nathanson retractors (n=82) were used for liver retraction. Serum liver enzyme levels were measured preoperatively and on the first, second, third, fifth, and seventh postoperative days. Clinicopathologic features and postoperative recovery variables between the 2 groups were compared. The aspartate aminotransferase, alanine aminotransferase, and C-reactive protein levels were significantly lower (P<0.001, P<0.001, and P=0.007, respectively), and the day of first flatus, the day of initiating a soft diet, and the length of hospital stay were shorter in the Nelaton catheter U-shaped retractor group than those seen in the Nathanson retractor group (P=0.035, P=0.002, and P=0.024, respectively). Atraumatic liver retraction with Nelaton catheters is recommended in laparoscopic gastrectomy.
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Application of Laparoscopic Gastrectomy in Obese Patients (BMI≥30 kg/m2) with Gastric Cancer: A Comparison With Open Gastrectomy Regarding Short-term Outcomes. Surg Laparosc Endosc Percutan Tech 2017; 28:e18-e23. [PMID: 29176372 DOI: 10.1097/sle.0000000000000497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Few studies have compared the surgical outcomes of laparoscopic (LG) and open (OG) gastrectomy in obese patients (BMI≥30 kg/m) with gastric cancer. The current study aimed to investigate the short-term outcomes of LG in this group of patients. METHODS A total of 33 LG cases and 23 OG cases (BMI≥30 kg/m) were identified from our gastric cancer database. Clinicopathologic features, operative details, laboratory examination, and postoperative outcomes were compared between both groups. Regression analysis was used to determine the effects of BMI on intraoperative outcomes. RESULTS The 2 groups had comparable clinicopathologic characteristics. LG was associated with significantly lesser blood loss, whereas both also groups had a similar operative time, and number of harvested lymph nodes. However, regression analysis indicated that increased BMI affected the operative time and blood loss in patients that underwent OG but had little effect on patients who received LG. The elevation of inflammatory factors (WBC, CRP) was lower in LG than in OG, postoperatively. Postoperative hepatic (alanine aminotransferase, total bilirubin, albumin) and renal (creatinine, blood urea nitrogen) functions in the LG group were not worse than in the OG group. The time to first flatus, initiation of diet, hospitalization, and postoperative complications seemed superior in LG than in OG, but these differences were not statistically significant. CONCLUSION LG can be safely performed in obese gastric cancer patients. Compared with conventional OG, LG is less invasive and is characterized by less blood loss and milder surgical trauma. LG is also less adversely affected by increased BMI.
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Comparison of the effects of spinal epidural and general anesthesia on coagulation and fibrinolysis in laparoscopic cholecystectomy: a randomized controlled trial: VSJ Competition, 2 nd place. Wideochir Inne Tech Maloinwazyjne 2017; 12:330-340. [PMID: 29062459 PMCID: PMC5649509 DOI: 10.5114/wiitm.2017.70249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/20/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors. Aim This randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis. Material and methods This randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups. Results The mean age was 51.5 ±16.7 years (range: 19–79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups. Conclusions While there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.
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Eun HS, Lee BS, Kwon IS, Yun GY, Lee ES, Joo JS, Sung JK, Moon HS, Kang SH, Kim JS, Shin HJ, Kim TK, Chun K, Kim SH. Advantages of Laparoscopic Radiofrequency Ablation Over Percutaneous Radiofrequency Ablation in Hepatocellular Carcinoma. Dig Dis Sci 2017; 62:2586-2600. [PMID: 28744835 DOI: 10.1007/s10620-017-4688-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inoperable hepatocellular carcinoma (HCC) can be treated with laparoscopic radiofrequency ablation (LRFA), which is generally a more accurate and accessible procedure than percutaneous RFA (PRFA). However, few studies have compared survival outcomes between LRFA and PRFA in patients with HCC. AIMS This study aimed to compare the efficacy of LRFA and PRFA for HCC treatment. METHODS Patients who underwent PRFA or LRFA as an initial treatment modality between April 2005 and April 2016 were enrolled in this study. The overall and recurrence-free survival rates were examined for each patient. Additionally, propensity score matching was performed for both groups. RESULTS The baseline characteristics of patients in the PRFA and LRFA groups showed several minor differences. Multivariate analysis showed that the RFA method was not a critical determinant of recurrence-free or overall survival (p = 0.069 and p = 0.406). Among patients who underwent RFA as the initial treatment modality, there was no significant effect between either RFA procedures on survival. After propensity score matching, univariate analysis showed a significant difference in overall survival between PRFA and LRFA (p = 0.031). Multivariate analysis showed that LRFA is a strong factor that contributed to an improved overall survival in HCC patients (hazard ratio 0.108, p = 0.040). Furthermore, our data showed that LRFA was able to limit multiple intrahepatic recurrences, as well as prevent marginal recurrence. CONCLUSIONS LRFA appears to be superior to PRFA in terms of survival. LRFA may help reduce mortality in HCC patients.
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Affiliation(s)
- Hyuk Soo Eun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea. .,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Gee Young Yun
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jong Seok Joo
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hae Jin Shin
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Tae Kyun Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea.,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, Chungnam National University Hospital, 282 Munwha-ro, Jung-gu, Daejeon, 34952, Republic of Korea. .,Department of Internal Medicine, School of Medicine, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon, 35015, South Korea.
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Fatal pulmonary embolism following splenectomy in a patient with Evan's syndrome: case report and review of the literature. Thromb J 2017; 15:18. [PMID: 28680366 PMCID: PMC5496165 DOI: 10.1186/s12959-017-0141-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022] Open
Abstract
Background Evans syndrome (ES) is a rare disease characterized by simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) with or without immune neutropenia. Splenectomy is one of the treatment options for disease refractory to medical therapy. Venous thromboembolism (VTE) following splenectomy for hematological diseases has an incidence of 10%. Case presentation Here we describe a case report of a young patient hospitalized with severe hemolytic anemia with Hgb 4.8 g/dl. He developed thrombocytopenia with platelet nadir of 52,000/mm3, thus formally diagnosed with ES. He failed standard medical therapy. He underwent splenectomy and had a fatal outcome. Autopsy confirmed the cause of death as pulmonary embolism (PE). Conclusions This case report and review of the literature highlight important aspects of the association between VTE, splenectomy, and hemolytic syndromes including the presence of thrombocytopenia. The burden of the disease is reviewed as well as various pathophysiologic mechanisms contributing to thromboembolic events in these patients and current perioperative prophylactic anticoagulation strategies. Despite an advancing body of literature increasing awareness of VTE following splenectomy, morbidity and mortality remains high. Identifying high risk individuals for thromboembolic complications from splenectomy remains a challenge. There are no consensus guidelines for proper perioperative and post-operative anti-coagulation. We encourage future research to determine which factors might be playing a role in increasing the risk for VTE in real time with hope of forming a consensus to guide management.
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Maerz D, Beck L, Sim A, Gainsburg D. Complications of robotic-assisted laparoscopic surgery distant from the surgical site. Br J Anaesth 2017; 118:492-503. [DOI: 10.1093/bja/aex003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Seo KI, Kim SE, Park MI, Park SJ, Moon W, Kim JH, Jung K, Park JG. Recurrent Abdominal Pain after Laparoscopic Appendectomy. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2017; 69:187-190. [PMID: 28329922 DOI: 10.4166/kjg.2017.69.3.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Laparoscopic surgical approaches, compared with open surgical approaches, provide comparable clinical outcomes, but lower complications. Unfortunately, a rare complication-portomesenteric vein thrombosis-had been reported after laparoscopic surgery. A 42-year-old woman was referred our hospital for recurrent abdominal pain after laparoscopic appendectomy from acute appendicitis. It was determined that abdominal pain was due to postoperative superior mesenteric vein thrombus. A six-month anticoagulation therapy is an excellent treatment for superior mesenteric vein thrombus . Therefore, physicians should be aware of portomesenteric vein thrombosis in patients with newly developed abdominal pain after successful laparoscopic surgical management.
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Affiliation(s)
- Kwang Il Seo
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jung Gu Park
- Department of Radiology, Kosin University College of Medicine, Busan, Korea
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Goh YM, Tokala A, Hany T, Pursnani KG, Date RS. Portomesenteric venous thrombosis: A rare but probably under-reported complication of laparoscopic surgery: A case series. J Minim Access Surg 2017; 13:143-145. [PMID: 28281480 PMCID: PMC5363122 DOI: 10.4103/0972-9941.195582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Portomesenteric venous thrombosis (PMVT) is a rare but well-reported complication following laparoscopic surgery. We present three cases of PMVT following laparoscopic surgery. Our first case is a 71-year-old morbidly obese woman admitted for elective laparoscopic giant hiatus hernia (LGHH) repair. Post-operatively, she developed multi-organ dysfunction and computed tomography scan revealed portal venous gas and extensive small bowel infarct. The second patient is a 51-year-old man with known previous deep venous thrombosis who also had elective LGHH repair. He presented 8 weeks post-operatively with severe abdominal pain and required major bowel resection. Our third case is an 86-year-old woman who developed worsening abdominal tenderness 3 days after laparoscopic right hemicolectomy for adenocarcinoma and was diagnosed with an incidental finding of thrombus in the portal vein. She did not require further surgical intervention. The current guidelines for thromboprophylaxis follow-up in this patient group may not be adequate for the patients at risk. Hence, we propose prolonged period of thromboprophylaxis in the patients undergoing major laparoscopic surgery.
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Affiliation(s)
- Yan Mei Goh
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Ajay Tokala
- Department of Radiology, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Tarek Hany
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Kishore G Pursnani
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Ravindra S Date
- Department of Upper Gastrointestinal Surgery, Lancashire Teaching Hospitals NHS Trust, Preston, UK
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What is the optimal treatment of superior mesenteric vein/portal vein thrombosis after bariatric surgery? Is SMA-directed t-PA the answer? Surg Obes Relat Dis 2017; 13:533-537. [DOI: 10.1016/j.soard.2016.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 12/22/2022]
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Colonic Necrosis Following Laparoscopic High Anterior Resection for Sigmoid Colon Cancer: Case Report and Review of the Literature. Int Surg 2017. [DOI: 10.9738/intsurg-d-17-00001.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a patient who experienced colonic necrosis after laparoscopic high anterior resection for sigmoid colon cancer, and review the literature to evaluate the clinical features of colonic necrosis following surgery for sigmoid colon and rectal cancer. A 76-year-old man with sigmoid colon cancer underwent laparoscopic high anterior resection. The operation included high ligation of the inferior mesenteric artery and end-to-end anastomosis using circular staples. Pathology findings revealed a pT4N2M0 lesion. Beginning on postoperative day (POD) 1, the patient experienced a high, spiking fever, and gradually developed leukocytosis and high inflammatory condition. The patient complained of abdominal distention, but had no signs of peritonitis. Abdominal computed tomography on POD4 showed wall thickness of the proximal colon from the anastomosis site and ascites with free air. An anastomotic leakage was suspected. Emergency laparotomy revealed a disrupted anastomosis without feces in the abdomen and a gangrenous 15 cm segment of the colon proximal to the anastomosis. The affected area of the colon was excised and Hartmann's procedure was performed. His postoperative period was uneventful. Our review of the literature demonstrates that elderly male patients with cardiovascular and pulmonary complications undergoing laparoscopic sigmoid and rectal cancer surgery with high ligation have high risk of postoperative colonic necrosis. We experienced colonic necrosis following laparoscopic high anterior resection for sigmoid colon cancer and required immediate resection. Elderly male patients with cardiovascular and pulmonary complications undergoing laparoscopic sigmoid and rectal cancer surgery with high ligation should be carefully monitored for postoperative colonic necrosis.
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Belnap L, Rodgers GM, Cottam D, Zaveri H, Drury C, Surve A. Portal vein thrombosis after laparoscopic sleeve gastrectomy: presentation and management. Surg Obes Relat Dis 2016; 12:1787-1794. [DOI: 10.1016/j.soard.2016.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
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Villagrán R, Smith G, Rodriguez W, Flores C, Cariaga M, Araya S, Yañez M, Fuentes P, Linares J, Zapata A. Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Incidence, Analysis and Follow-Up in 1236 Consecutive Cases. Obes Surg 2016; 26:2555-2561. [PMID: 27079191 PMCID: PMC5069330 DOI: 10.1007/s11695-016-2183-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). METHODS This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. RESULTS A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m2. Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. CONCLUSIONS PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes.
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Affiliation(s)
- Rodrigo Villagrán
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile.
| | - Gabriela Smith
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Walter Rodriguez
- Department of Radiology, Bupa Antofagasta Clinic, Antofagasta, Chile
| | - Carlos Flores
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Mario Cariaga
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Sofía Araya
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Marisol Yañez
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
| | - Paulina Fuentes
- Bariatric Surgery Department, Bupa Antofagasta Clinic, Matta 1868, 2nd floor, Antofagasta, Chile
- Faculty of Medicine and Dentistry, Antofagasta University, Antofagasta, Chile
| | - Jeannette Linares
- Endocrinology Department, Bupa Antofagasta Clinic, Antofagasta, Chile
- Faculty of Medicine and Dentistry, Antofagasta University, Antofagasta, Chile
| | - Antonio Zapata
- Endocrinology Department, Bupa Antofagasta Clinic, Antofagasta, Chile
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Comparison of the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery in the Trendelenburg position: study protocol for a randomized controlled trial. Trials 2016; 17:488. [PMID: 27724965 PMCID: PMC5057242 DOI: 10.1186/s13063-016-1609-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Robot-assisted laparoscopic radical prostatectomy and robot-assisted radical cystectomy have gradually become the preferred choices for urologists as they allow surgeons to perform complex procedures more precisely and effectively. The pneumoperitoneum, which is normally applied in these surgeries to provide visual clarity and space to perform the procedure, may cause hemodynamic disturbance, potentially myocardial injury. Thus surgeons have recently considered opting for the low-pressure pneumoperitoneum to lower this negative impact. Herein we describe a protocol for a clinical trial to compare the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery. Methods/design This study is designed to be a bicenter clinical trial. In total 280 patients scheduled to undergo robot-assisted laparoscopic radical prostatectomy or robot-assisted radical cystectomy will be enrolled and randomized into two groups, with standard- (12–16 mmHg) and low-pressure (7–10 mmHg) pneumoperitoneum, respectively. Troponin T will be measured as the primary endpoint to assess the extent of myocardial injury. Nt-proBNP and hemodynamic indexes will also be recorded for further analysis. Discussion The significance of this study is emphasized by the fact that there are few studies that have focused on the impact of prolonged pneumoperitoneum on myocardial injury, which is relevant to postoperative mortality. We hope that the conclusions drawn from this study could provide reference and basis to the future of the pneumoperitoneum in clinical practice. Trial registration Registered at https://www.clinicaltrials.gov with the Identifier NCT02600481 on November 5, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1609-5) contains supplementary material, which is available to authorized users.
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Donmez T, Uzman S, Yildirim D, Hut A, Avaroglu HI, Erdem DA, Cekic E, Erozgen F. Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy? PeerJ 2016; 4:e2375. [PMID: 27651988 PMCID: PMC5018660 DOI: 10.7717/peerj.2375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/28/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia. MATERIAL AND METHODS Fifty American Society of Anesthesiologist (ASA) I-III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n = 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups. RESULTS PT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24. CONCLUSION Both the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis.
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Affiliation(s)
- Turgut Donmez
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Sinan Uzman
- Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Dogan Yildirim
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Adnan Hut
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | | | - Duygu Ayfer Erdem
- Department of Anesthesiology and Reanimation, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Erdinc Cekic
- Department of Ear Nose Throat Surgery, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Fazilet Erozgen
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
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Glantzounis GK, Tsimaris I, Tselepis AD, Thomas C, Galaris DA, Tsimoyiannis EC. Alterations in Plasma Oxidative Stress Markers After Laparoscopic Operations of the Upper and Lower Abdomen. Angiology 2016; 56:459-65. [PMID: 16079930 DOI: 10.1177/000331970505600414] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The patient’s position during laparoscopic surgery can have a clinically relevant effect on lower limb and splanchnic circulation; this factor has not yet been investigated with respect to oxidative stress markers. In order to assess this effect, a prospective clinical trial was designed wherein 2 groups of patients were studied. In group A, 15 patients underwent upper abdominal nonhepatobiliary operations (13 modified Nissen fundoplications and 2 Taylor vagotomies) in the head-up position. In group B, 15 patients underwent lower abdominal operations (10 laparoscopic colectomies and 5 inguinal hernia repairs) in the head-down position. The pneumoperitoneum was maintained at 14 mm Hg in all cases. Plasma concentrations of thiobarbituric-acid reactive substances (TBARS), a marker of lipid peroxidation, plasma total antioxidant status (TAS), and serum uric acid concentrations were measured preoperatively, 5 minutes after deflation of the pneumoperitoneum, and 24 hours postoperatively. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum activities were measured preoperatively and 24 hours postoperatively. In group A, there was a significant increase in TBARS levels (p<0.005) immediately after deflation of the pneumoperitoneum and a significant decrease in TAS and uric acid levels (p<0.005) in the first postoperative day. There was also a significant postoperative elevation in both ALT and AST activities (p<0.001). In group B, no significant increase was found in postoperative TBARS or transaminase levels. TAS and uric acid levels decreased significantly in the first postoperative day (p<0.05) and (p<0.005, respectively). In conclusion, these results show that a combination of pneumoperitoneum and the head-up position causes significant increase in lipid peroxidation, decrease in plasma TAS, and increase in transaminases. The mechanism responsible for these events could be the low-flow ischemia-reperfusion syndrome induced by the pneumoperitoneum and aggravated by the head-up position.
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Affiliation(s)
- G K Glantzounis
- Department of Surgery, G. Hatzikosta General Hospital, Ioannina, Greece
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El Lakis MA, Pozzi A, Chamieh J, Safadi B. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass: a 36-case series. Surg Endosc 2016; 31:1005-1011. [PMID: 27387181 DOI: 10.1007/s00464-016-5078-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/24/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Portomesenteric vein thrombosis following laparoscopic bariatric surgical procedures is a serious and potentially lethal complication. It is quite rare, and its clinical presentation, management, and sequelae remain poorly understood. METHODS We searched PubMed, Medline, Google Scholar, Ovid, and Cochrane databases for articles reporting case series and systematic reviews in the English language on patients who underwent laparoscopic bariatric surgery and had a subsequent portal or mesenteric vein thrombosis. Articles discussing laparoscopic gastric banding were excluded. RESULTS A total of 14 articles reporting on 36 cases were found. We analyzed the pooled data from these case reports and series with emphasis on number of reported patients, demographics, time of diagnosis, risk factors, symptoms, management, complications, and sequelae. CONCLUSIONS Portomesenteric vein thrombosis is not uncommon following laparoscopic bariatric surgery and appears to occur more after laparoscopic sleeve gastrectomy. Bariatric surgeons should have a high index of suspicion for early detection and treatment of this potentially lethal complication. Obese patients at high risk for venous thrombosis should be screened for genetic predisposition for hypercoagulable state and should be considered for extended thromboprophylaxis postoperatively.
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Affiliation(s)
- Mustapha A El Lakis
- Department of General and Thoracic Surgery, Virginia Mason Medical Center, 1100 Ninth Ave. C6-SUR, Seattle, WA, USA.
| | - Agostino Pozzi
- Department of General Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Jad Chamieh
- Department of Surgery, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Bassem Safadi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Surjan RC, Makdissi FF, Basseres T, Leite D, Charles LF, Bezerra RO, Schadde E, Machado MA. First totally laparoscopic ALPPS procedure with selective hepatic artery clamping: Case report of a new technique. Medicine (Baltimore) 2016; 95:e4236. [PMID: 27442648 PMCID: PMC5265765 DOI: 10.1097/md.0000000000004236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/10/2016] [Accepted: 06/20/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is a new surgical approach for the treatment of liver tumors. It is indicated in cases where the future liver remnant is not sufficient to maintain postoperative liver function. We report a totally laparoscopic ALPPS with selective hepatic artery clamping. Pneumoperitoneum itself results in up to 53% of portal vein flow and selective hepatic artery clamping can reduce blood loss while maintaining hepatocellular function. Therefore, the combination of both techniques may result in effective control of bleeding with no damage in the liver function that may have direct impact in the result of ALPPS procedure. METHODS A 65-year-old man with colorectal liver metastases in all liver segments, except liver segment 1 (S1), were evaluated as unresectable. He underwent chemotherapy with objective response and multidisciplinary board decided for ALPPS procedure. First stage was performed entirely by laparoscopy and consisted of enucleation of metastases from segments 2 and 3, ligation of the right portal vein and liver splitting under selective common hepatic artery clamping. The second stage was done 3 weeks later and consisted of laparoscopic right trisectionectomy by laparoscopy. RESULTS Operative time was 250 and 200 minutes, respectively. Estimated blood loss was 150 and 100 mL. There was no need for transfusion or hospitalization in intensive care. He was discharged on the 3rd and 5th postoperative day, respectively. Recovery was uneventful after both stages and patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. Computerized tomography (CT) scan before second stage showed a liver hypertrophy of 53%, sFLR was 0.37 before second stage, or 33% of the total liver volume. CT scan shows no residual liver disease and optimum liver regeneration. Patient is well with no evidence of the disease 11 months after the procedure. CONCLUSIONS Totally laparoscopic ALPPS is a feasible and safe approach for selected patients with liver tumors. The hypertrophy of the remaining liver was adequate and sequential procedures were performed without morbidity and no mortality. Selective hepatic artery clamping seems to be an interesting solution to decrease intraoperative blood loss without the harsh effect of Pringle maneuver.
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