Milena Scepanovic, Tomislav Randjelovic, Aleksandar Karamarkovic, Vladimir Cuk, Goran Stanojevic, Bojan Kovacevic
Objective
The most important factor in abdominal surgery is the successful healing of the intestinal anastomosis performed. This study aims to evaluate the role of C-reactive protein (CRP) in predicting anastomotic dehiscence in the first week following surgery.
Methods
The study included 100 patients surgically treated over a period of 1 year. Postoperative (p/o) values of CRP, leukocyte (white blood cells [WBCs]) and body temperature (BT) were measured in relation to the development of p/o complications.
Results
CRP p/o values were significantly higher in patients with complications and proved helpful in predicting p/o complications, while WBC and BT were not. For the development of anastomotic leakage, receiver operating characteristic curve shows the earliest diagnostic accuracy on the third p/o day with the cut-off value of 115.1 mg/L; however, the largest area under the curve was on the fifth p/o day with a cut-off value of 59.2 mg/L, a sensitivity of 89%, a specificity of 61%, a positive predictive value (PPV) of 21.9 and a negative predictive value (NPV) of 100.
Conclusions
Measurement of p/o CRP values may indicate problematic healing of digestive tract anastomosis before the appearance of clinical signs. High sensitivity and high NPV allow us to rule out p/o complications and anastomotic dehiscence with great certainty and safely discharge these patients from the hospital.
{"title":"C-reactive protein as an early predictor of anastomotic dehiscence in various types of reconstruction in elective abdominal surgery","authors":"Milena Scepanovic, Tomislav Randjelovic, Aleksandar Karamarkovic, Vladimir Cuk, Goran Stanojevic, Bojan Kovacevic","doi":"10.1111/1744-1633.12646","DOIUrl":"10.1111/1744-1633.12646","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The most important factor in abdominal surgery is the successful healing of the intestinal anastomosis performed. This study aims to evaluate the role of C-reactive protein (CRP) in predicting anastomotic dehiscence in the first week following surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 100 patients surgically treated over a period of 1 year. Postoperative (p/o) values of CRP, leukocyte (white blood cells [WBCs]) and body temperature (BT) were measured in relation to the development of p/o complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CRP p/o values were significantly higher in patients with complications and proved helpful in predicting p/o complications, while WBC and BT were not. For the development of anastomotic leakage, receiver operating characteristic curve shows the earliest diagnostic accuracy on the third p/o day with the cut-off value of 115.1 mg/L; however, the largest area under the curve was on the fifth p/o day with a cut-off value of 59.2 mg/L, a sensitivity of 89%, a specificity of 61%, a positive predictive value (PPV) of 21.9 and a negative predictive value (NPV) of 100.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Measurement of p/o CRP values may indicate problematic healing of digestive tract anastomosis before the appearance of clinical signs. High sensitivity and high NPV allow us to rule out p/o complications and anastomotic dehiscence with great certainty and safely discharge these patients from the hospital.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"205-215"},"PeriodicalIF":0.8,"publicationDate":"2023-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76305102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haitham Shoman PhD, Simone Sandler MPH, Alexander Peters MPH, Ameer Farooq, Magdalena Gruendl, Shauna Trinh, James Little, Alex Woods, William Bolton, Abubakar Abioye, David Ljungman
Background
Gasless laparoscopy (GL) emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource-limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of GL compared with conventional laparoscopy (CL) and laparotomy.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Medline, Embase, Web of Science and Cochrane databases were searched. Variables of interest were determined a priori and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.
Results
Of the 1080 studies screened, a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomised studies. In these, the mean setup time for gasless and CL was 13.14 (95% CI −0.16 to 26.44) and 12.8 (95% CI −10.86 to 36.47) minutes, respectively. The mean duration of surgery for gasless and CL was 89.39 (95% CI 77.44 to 101.34) and 72.59 (95% CI 63.44 to 81.74) minutes, respectively, and the mean length of stay was 4.25 (95% CI 2.02 to 6.48) and 4.04 (95% CI 1.72 to 6.36) days, respectively. Most reported complications were haemorrhage and infection with no assessable statistical difference.
Conclusions
Although GL seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency are not sufficient to recommend GL as an alternative to CL or laparotomy. Larger randomised trials with a low risk of bias are warranted.
背景无气腹腔镜（GL）是为了克服气腹的临床和财务挑战而出现的，通常被视为在资源有限的环境中使用的一种可行的选择，以节省成本和资源。本研究旨在系统地回顾GL与传统腹腔镜（CL）和剖腹手术相比的安全性和有效性的现有证据。方法按照系统评价和荟萃分析首选报告项目（PRISMA）指南，检索Medline、Embase、Web of Science和Cochrane数据库。感兴趣的变量是先验确定的，Covidence软件用于筛选没有人口统计学偏好的纳入研究。使用Cochrane风险评估工具对研究质量进行评估。结果在筛选的1080项研究中，共纳入43项研究。腹腔镜胆囊切除术是迄今为止随机研究中研究最多的干预措施。其中，无气和CL的平均设置时间分别为13.14分钟（95%CI−0.16至26.44）和12.8分钟（95%CI−10.86至36.47）。无气和CL的平均手术时间分别为89.39（95%CI 77.44至101.34）和72.59（95%CI 63.44至81.74）分钟，平均住院时间分别为4.25（95%CI 2.02至6.48）和4.04（95%CI 1.72至6.36）天。大多数报告的并发症是出血和感染，没有可评估的统计差异。结论尽管GL似乎是许多普通外科干预措施的可行方法，但基于安全性和有效性的观察结果不足以推荐GL作为CL或剖腹手术的替代方案。有必要进行较低偏倚风险的大型随机试验。
{"title":"Gasless laparoscopy versus conventional laparoscopy and laparotomy: A systematic review on the safety and efficiency","authors":"Haitham Shoman PhD, Simone Sandler MPH, Alexander Peters MPH, Ameer Farooq, Magdalena Gruendl, Shauna Trinh, James Little, Alex Woods, William Bolton, Abubakar Abioye, David Ljungman","doi":"10.1111/1744-1633.12643","DOIUrl":"https://doi.org/10.1111/1744-1633.12643","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gasless laparoscopy (GL) emerged to overcome the clinical and financial challenges of pneumoperitoneum and is often seen as a viable option for use in resource-limited settings as a means of saving costs and resources. This study aims to systematically review the evidence available on the safety and efficiency of GL compared with conventional laparoscopy (CL) and laparotomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, Medline, Embase, Web of Science and Cochrane databases were searched. Variables of interest were determined <i>a priori</i> and Covidence software was used to screen studies for inclusion without demographic preference. The quality of studies was assessed using the Cochrane Risk Assessment tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1080 studies screened, a total of 43 studies were included. Laparoscopic cholecystectomy was by far the most studied intervention in randomised studies. In these, the mean setup time for gasless and CL was 13.14 (95% CI −0.16 to 26.44) and 12.8 (95% CI −10.86 to 36.47) minutes, respectively. The mean duration of surgery for gasless and CL was 89.39 (95% CI 77.44 to 101.34) and 72.59 (95% CI 63.44 to 81.74) minutes, respectively, and the mean length of stay was 4.25 (95% CI 2.02 to 6.48) and 4.04 (95% CI 1.72 to 6.36) days, respectively. Most reported complications were haemorrhage and infection with no assessable statistical difference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although GL seems to be a feasible approach for many general surgery interventions, the observed outcomes based on safety and efficiency are not sufficient to recommend GL as an alternative to CL or laparotomy. Larger randomised trials with a low risk of bias are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"171-186"},"PeriodicalIF":0.8,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1744-1633.12643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50131657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Practice February 2023 CME for fellows","authors":"","doi":"10.1111/1744-1633.12623","DOIUrl":"https://doi.org/10.1111/1744-1633.12623","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 2","pages":"121-122"},"PeriodicalIF":0.8,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50148336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We are rapidly approaching the 2-year anniversary since Vascular Surgery became a distinct speciality in surgery. Dr Chan addressed the importance of the subspeciality Vascular Nurse as an essential partner in modern vascular service. Dr Pang reviewed his 3-year results of advanced endovascular interventions for high-grade Trans-Atlantic Inter-Society Consensus-Class D (TASC-D) femoropopliteal inventions, and compared patency and clinical outcomes with the traditional bypass operations. [Extracted from the article] Copyright of Surgical Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
{"title":"Vascular Surgery 2023","authors":"Stephen Wing Keung Cheng","doi":"10.1111/1744-1633.12633","DOIUrl":"https://doi.org/10.1111/1744-1633.12633","url":null,"abstract":"We are rapidly approaching the 2-year anniversary since Vascular Surgery became a distinct speciality in surgery. Dr Chan addressed the importance of the subspeciality Vascular Nurse as an essential partner in modern vascular service. Dr Pang reviewed his 3-year results of advanced endovascular interventions for high-grade Trans-Atlantic Inter-Society Consensus-Class D (TASC-D) femoropopliteal inventions, and compared patency and clinical outcomes with the traditional bypass operations. [Extracted from the article] Copyright of Surgical Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 2","pages":"65"},"PeriodicalIF":0.8,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50148406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Please be reassured that I am not going to comment on the recent court case of gross negligent manslaughter in Hong Kong. But because we are moving into the ‘new normal’ after the COVID-19 (coronavirus disease 2019) pandemic, I think we should better equip ourselves in our capability and skills to handle incidents. This is a pragmatic approach because the painful reality is that incidents would not disappear from our practice. Healthcare (and surgical care in particular) is becoming increasingly complex. No matter how hard we try, somehow certain untoward events or incidents may happen to our patients. One good way to gain new insights into the management of clinical incidents would be to revise what have we learnt in the past. And let us look back into the 60s...
{"title":"Quality incident management","authors":"Paul B. S. Lai","doi":"10.1111/1744-1633.12634","DOIUrl":"https://doi.org/10.1111/1744-1633.12634","url":null,"abstract":"Please be reassured that I am not going to comment on the recent court case of gross negligent manslaughter in Hong Kong. But because we are moving into the ‘new normal’ after the COVID-19 (coronavirus disease 2019) pandemic, I think we should better equip ourselves in our capability and skills to handle incidents. This is a pragmatic approach because the painful reality is that incidents would not disappear from our practice. Healthcare (and surgical care in particular) is becoming increasingly complex. No matter how hard we try, somehow certain untoward events or incidents may happen to our patients. One good way to gain new insights into the management of clinical incidents would be to revise what have we learnt in the past. And let us look back into the 60s...","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 2","pages":"63-64"},"PeriodicalIF":0.8,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50148407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
3. Concerning post-operative pulmonary embolism A. It has a low mortality rate. ☐ ☐ B. It is a relatively uncommon post-operative complication. ☐ ☐ C. The diagnosis of post-operative pulmonary embolism might be underestimated. ☐ ☐ D. Patients with post-operative pulmonary embolism might be asymptomatic. ☐ ☐ E. Over-treating pulmonary embolism in asymptomatic patients might lead to adverse health consequences including increasing bleeding risk after anticoagulation ☐ ☐
{"title":"Surgical Practice May 2023 CME for Fellows","authors":"","doi":"10.1111/1744-1633.12632","DOIUrl":"https://doi.org/10.1111/1744-1633.12632","url":null,"abstract":"3. Concerning post-operative pulmonary embolism A. It has a low mortality rate. ☐ ☐ B. It is a relatively uncommon post-operative complication. ☐ ☐ C. The diagnosis of post-operative pulmonary embolism might be underestimated. ☐ ☐ D. Patients with post-operative pulmonary embolism might be asymptomatic. ☐ ☐ E. Over-treating pulmonary embolism in asymptomatic patients might lead to adverse health consequences including increasing bleeding risk after anticoagulation ☐ ☐","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 2","pages":"123-124"},"PeriodicalIF":0.8,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50148337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ho Chun Frederick Lau, Ming Fai Lin, Ki Kwong Li, Hoi Ming Herman Chan, Wing Shun Ng
Small ground-glass opacity intrapulmonary lesions without preoperative histological diagnosis are difficult to localise in minimal invasive thoracic surgery, especially in robotic-assisted surgery which has limited haptic feedback. Here we present two cases of using the LungPoint Virtual Bronchoscopic Navigation system for indocyanine green injection to assist with localization during robotic thoracic surgery, which might be a safe and feasible technique for such cases with impalpable lesions with no prior histological proof.
{"title":"Combined use of the Da Vinci robot system and the LungPoint Virtual Bronchoscopic Navigation system in the management of lung cancer: First Hong Kong experience","authors":"Ho Chun Frederick Lau, Ming Fai Lin, Ki Kwong Li, Hoi Ming Herman Chan, Wing Shun Ng","doi":"10.1111/1744-1633.12642","DOIUrl":"https://doi.org/10.1111/1744-1633.12642","url":null,"abstract":"<p>Small ground-glass opacity intrapulmonary lesions without preoperative histological diagnosis are difficult to localise in minimal invasive thoracic surgery, especially in robotic-assisted surgery which has limited haptic feedback. Here we present two cases of using the LungPoint Virtual Bronchoscopic Navigation system for indocyanine green injection to assist with localization during robotic thoracic surgery, which might be a safe and feasible technique for such cases with impalpable lesions with no prior histological proof.</p>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"187-189"},"PeriodicalIF":0.8,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50119348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emine Arici Parlak RN, PhD, Emine Iyigun RN, PhD, Sevinc Tastan RN, PhD, Mehmet Fatih Can MD
Objectives
The effects of using an abdominal binder after abdominal surgery on the development of incisional hernias in the long term are far from certain. This study aims to analyse the effects of abdominal binder use on the development of incisional hernia in the long term.
Methods
The population of this prospective cohort study included 84 patients, who underwent abdominal surgery and were evaluated for the effects of abdominal binder use between September 2013 and April 2014. The study sample comprised 57 patients (30 used an abdominal binder and 27 did not use one), who took part in the first research and agreed to participate. We conducted a telephone survey with the participants in September 2017 and asked them to answer the questions on the symptoms of and the risk factors associated with incisional hernia.
Results
Comparison of the two groups in terms of patient, surgical and treatment characteristics revealed no statistically significant difference (P > .05). Incisional hernia occurred in eight patients who used an abdominal binder and in five patients who did not use one. There was no statistically significant relationship between abdominal binder use and the development of incisional hernia 3 years after the abdominal surgery (P > .05).
Conclusions
This study found that abdominal binder use after abdominal surgery had no effects on the development of incisional hernia in the long term. Data on abdominal binder use were self-reported by the patients. Better designed cohort studies on larger populations may be conducted in the future.
{"title":"Effects of an abdominal binder on the development of incisional hernia in the long term: A prospective cohort study","authors":"Emine Arici Parlak RN, PhD, Emine Iyigun RN, PhD, Sevinc Tastan RN, PhD, Mehmet Fatih Can MD","doi":"10.1111/1744-1633.12640","DOIUrl":"https://doi.org/10.1111/1744-1633.12640","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The effects of using an abdominal binder after abdominal surgery on the development of incisional hernias in the long term are far from certain. This study aims to analyse the effects of abdominal binder use on the development of incisional hernia in the long term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The population of this prospective cohort study included 84 patients, who underwent abdominal surgery and were evaluated for the effects of abdominal binder use between September 2013 and April 2014. The study sample comprised 57 patients (30 used an abdominal binder and 27 did not use one), who took part in the first research and agreed to participate. We conducted a telephone survey with the participants in September 2017 and asked them to answer the questions on the symptoms of and the risk factors associated with incisional hernia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Comparison of the two groups in terms of patient, surgical and treatment characteristics revealed no statistically significant difference (<i>P</i> > .05). Incisional hernia occurred in eight patients who used an abdominal binder and in five patients who did not use one. There was no statistically significant relationship between abdominal binder use and the development of incisional hernia 3 years after the abdominal surgery (<i>P</i> > .05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study found that abdominal binder use after abdominal surgery had no effects on the development of incisional hernia in the long term. Data on abdominal binder use were self-reported by the patients. Better designed cohort studies on larger populations may be conducted in the future.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"138-147"},"PeriodicalIF":0.8,"publicationDate":"2023-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50140275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical management of unresectable perihilar cholangiocarcinoma is no longer relevant. Often these patients benefit from less invasive endoscopic or radiological management, but in the event of failure of these techniques, and in selected patients, cholangiojejunostomy in segment 3 can be an effective option. We describe the case of a 48-year-old patient presenting with an unresectable perihilar cholangiocarcinoma, in whom palliative endoscopic management failed two times and an open segment 3 intrahepatic cholangiojejunostomy was performed. The patient was discharged on the 7th day, has a complete resolution of jaundice at 2 months and is alive at 6 months without any readmission.
{"title":"Segment 3 cholangiojejunostomy for unresectable peri-hilar cholangiocarcinoma: A case report and literature review","authors":"Anisse Tidjane, Nabil Boudjenan, Nacim Ikhlef, Aicha Bengueddach, Sif-Elislem Meharzi, Hakim Larbi, Anissa Ourabah, Benali Tabeti","doi":"10.1111/1744-1633.12641","DOIUrl":"10.1111/1744-1633.12641","url":null,"abstract":"<p>Surgical management of unresectable perihilar cholangiocarcinoma is no longer relevant. Often these patients benefit from less invasive endoscopic or radiological management, but in the event of failure of these techniques, and in selected patients, cholangiojejunostomy in segment 3 can be an effective option. We describe the case of a 48-year-old patient presenting with an unresectable perihilar cholangiocarcinoma, in whom palliative endoscopic management failed two times and an open segment 3 intrahepatic cholangiojejunostomy was performed. The patient was discharged on the 7th day, has a complete resolution of jaundice at 2 months and is alive at 6 months without any readmission.</p>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"239-243"},"PeriodicalIF":0.8,"publicationDate":"2023-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72374967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehdi Shafiei, Masih Sabouri, Bahram Aminmansour, Mehdi Mahmoodkhani, Arman Sourani, Iman Salehi, Mina Foroughi
Aim
Patients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.
Patients and Methods
This study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur-hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (n = 66, enoxaparin initiation 24 h after operation) and control (n = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; P value <.05 was defined significant.
Results
A total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow-up duration was 19.139 ± 2.2 months. Long-term recurrence rate was 2.4% (n = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (P = .031).
Conclusion
In terms of VTE chemoprophylaxis, following bur-hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.
{"title":"Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes","authors":"Mehdi Shafiei, Masih Sabouri, Bahram Aminmansour, Mehdi Mahmoodkhani, Arman Sourani, Iman Salehi, Mina Foroughi","doi":"10.1111/1744-1633.12639","DOIUrl":"https://doi.org/10.1111/1744-1633.12639","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Patients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur-hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (<i>n</i> = 66, enoxaparin initiation 24 h after operation) and control (<i>n</i> = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; <i>P</i> value <.05 was defined significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow-up duration was 19.139 ± 2.2 months. Long-term recurrence rate was 2.4% (<i>n</i> = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (<i>P</i> = .031).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In terms of VTE chemoprophylaxis, following bur-hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"153-162"},"PeriodicalIF":0.8,"publicationDate":"2023-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50140274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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