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Lo HC, Hsu SC, Soong RS, Huang SK. Unraveling Postoperative Bleeding Dynamics in Laparoscopic Roux-en-Y Gastric Bypass: Insights from a Single-Center Tranexamic Acid Study. Obes Surg 2024; 34:3012-3020. [PMID: 39037676 DOI: 10.1007/s11695-024-07411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The efficacy of postoperative tranexamic acid (TXA) administration in mitigating bleeding after primary laparoscopic Roux-en-Y gastric bypass (RYGB), a prevalent complication associated with significant morbidities and mortality, and the use of sequential laboratory parameter changes in bleeding screening and TXA impact tracking were investigated. METHODS This retrospective analysis included RYGB patients (aged 18-65 years, with a body mass index of 35-50 kg/m2) over 5 years who were categorized into three groups by evolving treatment regimens: Group A (n = 42) received standard pre- and postoperative enoxaparin (30 mg) every 12 h; Group B (n = 160) received enoxaparin and postoperative TXA (250 mg every 6 h); and Group C (n = 73) received TXA alone. Postoperative bleeding-related adverse events, vital signs, and laboratory changes were compared. RESULTS Postoperative hemorrhage occurred in 3.6% (10/275) of patients, with no significant intergroup differences. Patients who experienced bleeding had greater decreases in hemoglobin (∆Hb) (2.1 vs. 1.4; p = 0.003), greater ∆Hb > 2 (50% vs. 15%; p = 0.013), and greater use of staples than did those who did not experience bleeding (8 vs. 7; p = 0.001). The ∆Hb values were lower in Groups B (1.4) and C (1.3) than in Group A (1.7, p = 0.011). No significant difference was noted between Groups C and B. CONCLUSION This study emphasizes the potential of TXA to mitigate postoperative bleeding after RYGB, with no added benefit from excluding enoxaparin. Monitoring patients with a ∆Hb > 2 mg/dl and increased stapler usage is crucial. Further research is needed to validate routine TXA use across different procedures.
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Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Shih-Chang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ruey-Shyang Soong
- Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No.111 Sec.3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan
- College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 110, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Organ Transplantation, Taipei Medical University, College of Medicine, Medical University, Taipei, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
| | - Shau-Ku Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Johns Hopkins Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, USA
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Karmarkar R, Bodapati S, Yao L, Aroori S. A Foley catheter 'the jack of all trades': a literature review of its common and novel uses. Ann R Coll Surg Engl 2024; 106:485-491. [PMID: 37434583 PMCID: PMC11217819 DOI: 10.1308/rcsann.2023.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 07/13/2023] Open
Abstract
The Foley catheter is one of the most commonly used devices in modern surgical practice. Developed for draining the urinary bladder, this humble catheter has been employed for many other purposes ranging from urine output monitoring to complex urological investigations. Over time, it has evolved into being applied in more complex and innovative ways in various other specialties apart from urology. In this review article, we describe some of the common and novel uses of this deceptively simple device, and discuss the scope of its application in modern medicine.
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Affiliation(s)
| | - S Bodapati
- University Hospitals Plymouth NHS Trust, UK
| | - L Yao
- University Hospitals Plymouth NHS Trust, UK
| | - S Aroori
- University Hospitals Plymouth NHS Trust, UK
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Muensterer NR, Werner E, Muensterer OJ. Successful Foley catheter tamponade of an epigastric vessel trocar injury in a toddler - A case report. Int J Surg Case Rep 2021; 81:105779. [PMID: 33752031 PMCID: PMC7985414 DOI: 10.1016/j.ijscr.2021.105779] [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: 03/06/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
Epigastric vessel injury is a well recognized complication during laparoscopic trocar placement. Precautionary measures to prevent trocar induced injuries should be implemented to lower the incidence of this complication. If this complication is encountered, tamponade by Foley catheter placement is an effective measure to provide hemostasis. Hemorrhage control using a Foley catheter is feasible even in small children and toddlers.
Introduction and importance Injuries to the inferior epigastric vessels during laparoscopic surgery are rare but reported. They can lead to significant morbidity. We report the successful tamponade of a bleeding epigastric vessel during laparoscopic inguinal hernia repair in a child using a Foley catheter. A Foley catheter has not been routinely used in pediatric surgery for this indication so far. Case presentation A 32-month-old boy underwent laparoscopic left inguinal hernia repair. During insertion of a 2 mm trocar, the left inferior epigastric vessels were lacerated, leading to a brisk bleed into the abdominal wall and into the abdomen through the trocar site during the procedure. When the hemorrhage was noted, the trocar was removed. The trocar tract was slightly dilated using a blunt forceps and a 12 F Foley catheter was introduced into the abdomen. The balloon was insufflated with 10 ml of water and the catheter was retracted towards the abdominal wall, tamponading the bleed. The inguinal hernia repair was completed, and after desufflating the catheter at the end of the procedure, the hemorrhage had stopped. Clinical discussion Postoperatively, the hemoglobin had dropped by 1.5 g/dl to 9.3 g/dl. The patient was observed and then discharged on the same day. Besides an additional 2 mm scar in the right lower quadrant, he had no further sequellae or adverse effects. Conclusion Hemorrhage resulting from trocar injury of the inferior epigastric vessels during laparoscopy can be controlled by Foley catheter insertion and tamponade in children. Pediatric surgeons should be aware of this useful maneuver to manage this complication.
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Affiliation(s)
- Nadine R Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Evgenij Werner
- Department of Pediatric Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Pediatric Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Shimizu N, Tanaka Y, Kuroda S, Nakamura H, Matsumoto G, Mitsui S, Sakai S, Minami K, Doi T, Hokka D, Maniwa Y. Oxidized regenerated cellulose for a clear thoracoscopic view: a single-centre randomized trial. Interact Cardiovasc Thorac Surg 2020; 30:346-352. [PMID: 31747012 DOI: 10.1093/icvts/ivz271] [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: 07/20/2019] [Revised: 10/12/2019] [Accepted: 10/18/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES During video-assisted thoracoscopic surgery (VATS), blood oozing from the surface of the access port wound can hamper the surgical view. Although this oozing is difficult to prevent, it can be decreased by placing a wound edge protector with oxidized regenerated cellulose (ORC) on the surface of the access port wound, thereby improving the surgical outcomes and safety of VATS. METHODS We conducted a prospective, single-centre, open-label, randomized clinical trial to evaluate the operative outcomes of VATS when using the ORC (ORC group) compared with operative outcomes without using the ORC (non-ORC group). The primary end point was interruption of the operation as a result of blood oozing from the surface of the access port wound. The secondary end points were the other intraoperative and postoperative outcomes. RESULTS A total of 108 patients were divided into the ORC group (n = 54) and the non-ORC group (n = 54). Compared with the non-ORC group, the ORC group had fewer patients with an interruption in the operation (11.1% vs 51.8%; P < 0.001), less need for wound haemostasis of the access ports during wound closure (44.4% vs 72.2%; P = 0.003), similar rates of postoperative deaths and complications and a tendency for shorter operation times (149.3 vs 168.8 min, respectively; P = 0.083). CONCLUSION The use of an ORC sheet around a wound edge protector for haemostasis can ensure a clear view during VATS. CLINICAL TRIAL REGISTRATION NUMBER UMIN000031112.
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Affiliation(s)
- Nahoko Shimizu
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sanae Kuroda
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hayate Nakamura
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Gaku Matsumoto
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Suguru Mitsui
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuto Sakai
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiro Minami
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Criss CN, Ralls MW, Jarboe MD. Ultrasound-Guided Access into the Abdomen in the Setting of Portal Hypertension: A Novel Technique. J Laparoendosc Adv Surg Tech A 2016; 27:328-331. [PMID: 27858592 DOI: 10.1089/lap.2016.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
As the field of minimally invasive surgery rapidly evolves, there is an opportunity to adopt innovative techniques to accommodate a variety of patient populations. In patients with portal hypertension, a major risk factor upon entry into the abdomen is injury to large, engorged paraumbilical vessels in the anterior abdominal wall. Major blood loss often results from just entering the abdomen. Here, we describe a patient with caput medusae secondary to portal hypertension presenting for laparoscopic repair of a ventral hernia. Using ultrasound guidance, initial port placement into the abdomen was performed safely using needle access, Seldinger technique, and serial dilation for VersaStep™ 5 mm port (Medtronic, Minneapolis, MN) insertion. Overall, this innovative technique is a safe and effective method of entry into the abdomen in a patient with portal hypertension.
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Affiliation(s)
- Cory N Criss
- Department of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Matthew W Ralls
- Department of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
| | - Marcus D Jarboe
- Department of Pediatric Surgery, C.S. Mott Children's Hospital , Ann Arbor, Michigan
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Seo HS, Lee HH. Is the 5-ports approach necessary in laparoscopic gastrectomy? Feasibility of reduced-port totally laparoscopic gastrectomy for the treatment of gastric cancer: A Prospective Cohort Study. Int J Surg 2016; 29:118-22. [DOI: 10.1016/j.ijsu.2016.03.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/13/2016] [Accepted: 03/17/2016] [Indexed: 02/07/2023]
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