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Kılınç E, Yildirim SA, Ulugöl H, Büyüköner EE, Güçyetmez B, Toraman F. The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy. Front Med (Lausanne) 2023; 10:1273180. [PMID: 37822468 PMCID: PMC10563763 DOI: 10.3389/fmed.2023.1273180] [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: 08/05/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Objective This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. Design A prospective, observational study. Setting Single center. Participants Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. Measurements and main results All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 (p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive correlation between the delta-cardiac cycle efficiency and delta-longitudinal strain (R2 = 0.36, p < 0.001). Conclusion Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.
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Affiliation(s)
- Emir Kılınç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Serap Aktas Yildirim
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halim Ulugöl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Elif Eroğlu Büyüköner
- Department of Cardiology, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Bülent Güçyetmez
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Fevzi Toraman
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
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Collins CE, Renshaw S, Huang LC, Phillips S, Gure TR, Poulose B. Robotic vs. Open Approach for Older Adults Undergoing Retromuscular Ventral Hernia Repair. Ann Surg 2023; 277:697-703. [PMID: 35129505 DOI: 10.1097/sla.0000000000005260] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe 30-day outcomes including post-operative complications, readmissions, and quality of life score changes for older adults undergoing elective ventral hernia repair with retromuscular mesh placement and to compare rates of these outcomes for individuals undergoing robotic versus open approaches. SUMMARY OF BACKGROUND DATA Over one third of patients presenting for elective ventral hernia repair are over the age of 65 and many have complex surgical histories that warrant intricate hernia repairs. Robotic ventral hernia repairs have gained increasing popularity in the US and in some studies have demonstrated decreased rates of postoperative complications, and less pain resulting in shorter hospital stays. However, the robotic approach has several downsides including prolonged operative times as well as the use of pneumo-peritoneum which may be risky in older patients. METHODS We performed a retrospective review of prospectively collected data in a national hernia specific registry (the Abdominal Core Health Quality Collaborative) and identified patients over the age of 65 undergoing either an open or robotic retromuscular ventral hernia repair. After propensity score matching adjusting for demographic, clinical, and hernia related factors, logistic regression was used to compare 30-day complications, readmission, and quality of life (QoL) scores as captured by the HerQLes scale for patients undergoing each approach. RESULTS Of 2128 patients who met inclusion criteria, 1695 (79.7%) underwent open ventral hernia repair while 433 (20.3%) underwent robotic repair. After propensity score matching, there were 350 robotic cases and 759 open cases for analysis. Patients undergoing robotic repairs demonstrated significantly shorter length of stays (1 vs 4 days, P < 0.01) and had equivalent odds of both 30-day post-operative complications (odds ratio [OR] 1.15 95% confidence interval 0.92-1.44) and readmission (OR 1.09 95% confidence interval 0.74-1.6) compared to the open approach. QoL scores were similar between groups at 30 days but were slightly better for robotic patients at 1 year (92 vs 84 P < 0.01). CONCLUSIONS Robotic ventral hernia repair is an option for appropriately selected older patients undergoing retromuscular ventral hernia repair, demonstrating shorter hospital stays and equivalent rates of complications and readmissions in the post-operative period. However, more data is needed regarding QoL outcomes and long-term function, especially as it relates to recurrence rates, between the two approaches.
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Affiliation(s)
- Courtney E Collins
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH
| | - Savannah Renshaw
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH
| | - Li-Ching Huang
- Department of Surgery Vanderbilt University, Nashville, TN
| | | | - Tanya R Gure
- Department of Internal Medicine, Division of General Internal Medicine & Geriatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin Poulose
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH
- Department of Internal Medicine, Division of General Internal Medicine & Geriatrics, The Ohio State University Wexner Medical Center, Columbus, OH
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Kim HH, Ihn MH, Lee YH, Lee J, Yun S, Cho SW. Effect of Age on Laparoscopic Surgery and Postoperative Chemotherapy in Elderly Patients With Colorectal Cancer. Ann Coloproctol 2020; 36:229-242. [PMID: 32054245 PMCID: PMC7508477 DOI: 10.3393/ac.2019.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We aimed to evaluate the postoperative complications of laparoscopic colorectal cancer (CRC) surgery and the adverse events of postoperative chemotherapy in elderly patients compared to younger patients and to identify the factors influencing the termination of postoperative chemotherapy. METHODS Between June 2015 and May 2018, 188 patients with CRC underwent laparoscopic surgery with curative intent. Patients aged ≥ 70 were defined as elderly. Postoperative complications and adverse events of chemotherapy were assessed by using the Clavien-Dindo classification and the Common Terminology Criteria for Adverse Events, respectively. The clinicopathological factors were analyzed retrospectively. RESULTS Seventy-eight patients were considered elderly with a mean age of 77.5 ± 5.5 years. Overall postoperative complications occurred in 68 patients (36.2%). Age and primary tumor location were independent predictors of overall postoperative complications. Smoking history was the only independent predictor of major postoperative complications. Of 113 patients who were recommended postoperative chemotherapy, 90 patients (79.6%) received postoperative chemotherapy. Overall adverse events occurred in 40 patients (44.4%). The American Society of Anesthesiologists physical status classification and chemotherapy regimen were significantly associated with overall adverse events. The chemotherapy regimen was the only factor significantly associated with severe adverse events. Of 90 patients, postoperative chemotherapy could not be completed in 11 (12.2%). Age was the only factor significantly associated with stopping postoperative chemotherapy (P = 0.003). CONCLUSION This study shows that laparoscopic CRC surgery and postoperative chemotherapy were feasible in elderly patients. Further efforts are needed to ensure that elderly patients have the opportunity to make informed decisions regarding postoperative chemotherapy.
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Affiliation(s)
- Hyun Hee Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Myong Hoon Ihn
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Hee Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sangchul Yun
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Woo Cho
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Palsson SH, Engstrom C, Enochsson L, Osterlund E, Sandblom G. Risk factors for postoperative myocardial infarct following cholecystectomy: a population-based study. HPB (Oxford) 2020; 22:34-40. [PMID: 31327561 DOI: 10.1016/j.hpb.2019.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/21/2019] [Accepted: 06/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim was to analyse the risk for myocardial infarction (MI) after cholecystectomy. METHODS The study is based on data from the Swedish Register for Gallstone Surgery (GallRiks) 2006-2014. The cohort was cross-linked with the Swedish Patient Register. Standardised incidence ratio (SIR) was calculated by dividing the observed incidence of MI within 30 days after surgery with the expected incidence of the background population. RESULTS Altogether 94,577 procedures were included. MI within 30 days postoperatively (30d-po) were registered in 87 cases (0.09%, SIR for MI 3.03; 95% CI 2.43-3.74). MI occurred more often in men (0.15% vs 0.06%), after open surgery (0.34% vs 0.04%), was age related (age >50 years OR 4.05 > 75 years OR 15.70) and occurred more frequently amongst those with gallstone complications and high ASA score (ASA 1; 0.02%, 2; 0.08%, ≥3; 0,64%). The risk for MI within 30d-po was 52.8% if the patient had suffered an infarct within 8 weeks preoperatively. Laparoscopy converted to open and primarily open surgery were independent risk factors (OR 3.05 vs 2.19). The mortality in the group with 30d-po MI was 11.5% vs 0.02%. CONCLUSION Delaying elective cholecystectomy for at least 8 weeks after a recent MI reduces the risk for postoperative MI.
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Affiliation(s)
- Simon Henry Palsson
- Sahlgrenska Academy, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Cecilia Engstrom
- Sahlgrenska Academy, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Enochsson
- Department of Surgical and Perioperative Science, Division of Surgery, Umea University, Umea, Sweden
| | - Erik Osterlund
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriel Sandblom
- Karolinska Institute, Centre for Digestive Diseases, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Stockholm, Sweden
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Short–term outcomes of laparoscopic colorectal cancer surgery in elderly patients. -Is it really safe in elderly patients with severe comorbidities?-. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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La Falce S, Novara G, Gandaglia G, Umari P, De Naeyer G, D'Hondt F, Beresian J, Carette R, Penicka M, Mo Y, Vandenbroucke G, Mottrie A. Low Pressure Robot-assisted Radical Prostatectomy With the AirSeal System at OLV Hospital: Results From a Prospective Study. Clin Genitourin Cancer 2017; 15:e1029-e1037. [DOI: 10.1016/j.clgc.2017.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Li Y, Wang S, Gao S, Yang C, Yang W, Guo S. Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy. Tech Coloproctol 2016; 20:153-62. [PMID: 26783029 DOI: 10.1007/s10151-015-1419-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 12/25/2015] [Indexed: 01/01/2023]
Abstract
Octogenarians are more often viewed as high-risk surgical candidates. This increased risk is attributed to an age-related decline in physical function and reserve capacity coupled with the presence of various underlying diseases. There are no current guidelines or consensus on the optimal treatment strategy for this cohort of complex patients. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of laparoscopic colorectal resection versus open colorectal resection in octogenarians. The meta-analysis was conducted following all aspects of the Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature review was carried out using the following databases: MEDLINE, Embase, PubMed, the Cochrane Library, Google Scholar and OVID. Only studies comparing outcome of laparoscopic and open colorectal resections in the elderly population (≥80 years) were selected. The data collected included the patient demographics, interventions, observed outcome and sources of bias. When performing the statistical analysis, we used the odds ratio for categorical variables and the weighted mean difference for continuous variables. The results of this systematic review and pooled analysis demonstrated the safety and potential benefits of laparoscopic colorectal resection in octogenarians. LC can reduce the length of hospital stay, intraoperative blood loss, time to return of normal bowel function, and incidence of postoperative pneumonia, wound infection, and postoperative ileus.
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Affiliation(s)
- Y Li
- Department of Colorectal Surgery, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China.
| | - S Wang
- The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Medical University, No. 56 Xinjian Road South, Taiyuan, Shanxi, 030001, China
| | - S Gao
- Department of Colorectal Surgery, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
| | - C Yang
- The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Medical University, No. 56 Xinjian Road South, Taiyuan, Shanxi, 030001, China
| | - W Yang
- Department of Gastroenterology, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
| | - S Guo
- Department of Molecular Biology, The Affiliated Cancer Hospital of Shanxi Medical University, Shanxi Cancer Hospital and Institute, Taiyuan, Shanxi, China
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Xie M, Qin H, Luo Q, He X, Lan P, Lian L. Laparoscopic Colorectal Resection in Octogenarian Patients: Is it Safe? A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1765. [PMID: 26496302 PMCID: PMC4620785 DOI: 10.1097/md.0000000000001765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The population older than 80 years has been increasing. A significant proportion of colorectal diseases that require colorectal resection occur in very elderly patients. However, the benefits of laparoscopy remain controversial in octogenarians. A systematic review and meta-analysis of observational study was performed to compare clinical outcomes between laparoscopic versus open colorectal resection in octogenarians.The PubMed, EMBASE, Ovid, Web of Science, and Cochrane databases from the years 1990 to 2015 were searched for studies that compare surgical outcomes between laparoscopic and open colorectal resection in octogenarians (≥80 years old).Seven eligible studies including 528 laparoscopic and 484 open colorectal resections were identified. Laparoscopic approach was associated with lower rate of mortality (odds ratio [OR] 0.48, P = 0.03), overall complications (OR 0.54, P < 0.001), and prolonged ileus (OR 0.56, P = 0.009), quicker bowel function return (standardized mean difference [SMD] -0.50, P< 0.001), and shorter length of hospital stay (SMD -0.47, P = 0.007). No differences were found in anastomotic leak (OR 1.16, P = 0.72), respiratory complication (OR 0.60, P = 0.07), and reoperation (OR 0.85, P = 0.69).Laparoscopic colorectal resection is as safe as open approach, and the short-term outcomes appear to be more favorable in octogenarians.
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Affiliation(s)
- Minghao Xie
- From the Department of Colorectal Surgery (MX, HQ, QL, XH, PL, LL); and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China (MX, HQ, QL, XH, PL, LL)
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Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth 2014; 62:158-68. [DOI: 10.1007/s12630-014-0266-y] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/28/2014] [Indexed: 12/13/2022] Open
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Sadhu S, Sarkar S, Jahangir TA, Verma R, Shaikh F, Dubey SK, Roy MK. Laparoscopic cholecystectomy in patients with cardiac dysfunction. Indian J Surg 2010; 73:90-5. [PMID: 22468055 DOI: 10.1007/s12262-010-0175-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 10/27/2010] [Indexed: 11/27/2022] Open
Abstract
Laparoscopic cholecystectomy remains the standard treatment for cholelithiasis. Ever increasing number of patients with myriad of medical illness is being treated by this technique. However, significant concern prevails among the surgical community regarding its safety in patients with cardiac co-morbidity. Patients with significant cardiac dysfunction and multiple co-morbidities were prospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopic cholecystectomy was performed. Patient demographics, details of peri-operative management and post-operative complications were studied. Between March 2005 and January 2009, 28 patients (M:F = 21:7) with mean age of 60 years (range 26-78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy. Of these, 24 patients were in NYHA class-II, while 4 belonged to class-III. Left ventricular ejection fraction, as recorded by transthoracic echocardiography, was 20-30% in 13 (46%) patients and 30-40% in the rest 15 (54%). In addition, 13 (46%) patients had regional wall motion abnormalities, 11 (39%) patients had cardiomyopathy, 2 (7%) patients had valvular heart disease while 12 (43%) patients had prior cardiac interventions. Following laparoscopic cholecystectomy, hypertension (3), tachyarrhythmia (4) and bradycardia (1) were the commonest events encountered. One patient required laparotomy to deal with peritonitis in the immediate postoperative period and succumbed to myocardial infarction, but all other patients made an uneventful recovery. With appropriate cardiological support, laparoscopic cholecystectomy may be safely performed in patients with significant cardiac dysfunction.
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Affiliation(s)
- Sagar Sadhu
- Department of Surgery and MIS, Rabindranath Tagore International Institute of Cardiac Sciences, 124 Mukundapur, Kolkata, 700099 India
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Lian L, Kalady M, Geisler D, Kiran RP. Laparoscopic colectomy is safe and leads to a significantly shorter hospital stay for octogenarians. Surg Endosc 2010; 24:2039-43. [DOI: 10.1007/s00464-010-0900-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 01/06/2010] [Indexed: 12/13/2022]
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Laparoscopic cholecystectomy for acute cholecystitis in the elderly: is it safe? Surg Laparosc Endosc Percutan Tech 2009; 18:334-9. [PMID: 18716529 DOI: 10.1097/sle.0b013e318171525d] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the outcome of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis aged 75 years and older. MATERIALS AND METHODS A retrospective chart review was performed on the 1216 cholecystectomies performed in our department from 2000 to 2005. A total of 225 patients underwent attempted LC for acute cholecystitis, of whom 42 were more than 75 years old and 183 younger. RESULTS There was no difference in mean duration of symptoms before admission and length of hospital stay before surgery (3.8 d in elderly vs. 3.1 in younger patients, and 2.8 vs. 2.3 d, respectively). In all, 21% of the elderly patients had American Society of Anesthesiologists score III and IV. Mean operative time and conversion rate to open surgery were similar in both groups. Postoperative stay was longer in elderly (3.9 vs. 2.8). The postoperative complications rate and mortality were significantly higher in the elderly group (31% vs. 15%, and 4.8% vs. 0.5%, respectively). CONCLUSIONS LC in elderly patients suffering from acute cholecystitis is feasible and effective. It is associated with a higher rate of morbidity unrelated to the surgical site and mortality in elderly compared with younger patients. Stronger selection of elderly patients for surgery is needed.
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Umgelter A, Wagner K, Reindl W, Nurtsch N, Huber W, Schmid RM. Haemodynamic effects of plasma-expansion with hyperoncotic albumin in cirrhotic patients with renal failure: a prospective interventional study. BMC Gastroenterol 2008; 8:39. [PMID: 18752670 PMCID: PMC2556671 DOI: 10.1186/1471-230x-8-39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 08/27/2008] [Indexed: 12/14/2022] Open
Abstract
Background Patients with advanced cirrhosis of the liver typically display circulatory disturbance. Haemodynamic management may be critical for avoiding and treating functional renal failure in such patients. This study investigated the effects of plasma expansion with hyperoncotic albumin solution and the role of static haemodynamic parameters in predicting volume responsiveness in patients with advanced cirrhosis. Methods Patients with advanced cirrhosis (Child B and C) of the liver receiving albumin substitution because of renal compromise were studied using trans-pulmonary thermodilution. Paired measurements before and after two infusions of 200 ml of 20% albumin per patient were recorded and standard haemodynamic parameters such as central venous pressure (CVP), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), cardiac index (CI) and derived variables were assessed, including global end-diastolic blood volume index (GEDVI), a parameter that reflects central blood volume Results 100 measurements in 50 patients (33 m/17 w; age 56 years (± 8); Child-Pugh-score 12 (± 2), serum creatinine 256 μmol (± 150) were analyzed. Baseline values suggested decreased central blood volumes GEDVI = 675 ml/m2 (± 138) despite CVP within the normal range (11 mmHg (± 5). After infusion, GEDVI, CI and CVP increased (682 ml/m2 (± 128) vs. 744 ml/m2 (± 171), p < 0.001; 4.3 L/min/m2 (± 1.1) vs. 4.7 L/min/m2 (± 1.1), p < 0.001; 12 mmHg (± 6) vs. 14 mmHg (± 6), p < 0.001 respectively) and systemic vascular resistance decreased (1760 dyn s/cm5/m2 (± 1144) vs. 1490 dyn s/cm5/m2 (± 837); p < 0.001). Changes in GEDVI, but not CVP, correlated with changes in CI (r2 = 0.51; p < 0.001). To assess the value of static haemodynamic parameters at baseline in predicting an increase in CI of 10%, receiver-operating-characteristic curves were constructed. The areas under the curve were 0.766 (p < 0.001) for SVRI, 0.723 (p < 0.001) for CI, 0.652 (p = 0.010) for CVP and 0.616 (p = 0.050) for GEDVI. Conclusion In a substantial proportion of patients with advanced cirrhosis, plasma expansion results in an increase in central blood volume. GEDVI but not CVP behaves as an indicator of cardiac preload, whereas high baseline SVRI is predictive of fluid responsiveness.
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Affiliation(s)
- Andreas Umgelter
- II. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, D-81675 München, Germany.
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15
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Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L. Complicated Appendicitis: Laparoscopic or Conventional Surgery? World J Surg 2007; 31:744-9. [PMID: 17361359 DOI: 10.1007/s00268-006-0467-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The surgical treatment of complicated appendicitis remains controversial. The aim of this study was to evaluate the role of laparoscopic appendectomy in the treatment of complicated appendicitis in comparison with open surgery. METHODS We reviewed the medical records of all patients who underwent an appendectomy for complicated appendicitis between January 2001 and August 2005. RESULTS We identified 98 patients with complicated appendicitis. Forty-eight patients underwent open appendectomy, 42 laparoscopic appendectomy, and 8 initial laparoscopy with conversion to open surgery. Older patients, patients with comorbidities, and female patients were more likely to have been offered a laparoscopic appendectomy. Operating time, time to solid oral intake, and time of hospital stay were prolonged in the laparoscopic group but not significantly. There was no mortality observed in either group, and the complication rate was similar in both groups. CONCLUSIONS Laparoscopic appendectomy is an acceptable procedure for complicated appendicitis, with the same rate of infectious complications as the conventional approach.
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Affiliation(s)
- Boris Kirshtein
- Department of Surgery A, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of Negev, POB 151, 84101 Beer Sheva, Israel.
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Morales-Conde S, Gómez JC, Cano A, Sánchez-Matamoros I, Valdés J, Díaz M, Pérez A, Bellido J, Fernández P, Pérez R, López J, Martín M, Cantillana J. Ventajas y peculiaridades del abordaje laparoscópico en el anciano. Cir Esp 2005; 78:283-92. [PMID: 16420844 DOI: 10.1016/s0009-739x(05)70937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Both the age of the population and anesthetic and surgical techniques are advancing. Currently, 40% of surgical activity is performed in patients older than 65 years, who present a higher surgical risk than younger patients. The aim of treatment in the elderly is to provide the best possible quality of life, even though this represents a surgical challenge because of associated comorbidity and reduced cardiopulmonary reserve. From the moment at which laparotomy becomes an increased stress in the elderly, laparoscopic surgery can be particularly advantageous in this population. Therefore, minimally invasive surgery may have a greater impact in these individuals than in younger patients in reducing postoperative pain, cardiorespiratory complications, hospital stay, and recovery time before resuming physical activity. The recent advances in anesthesia, together with improved patient selection and perioperative cardiac care, and the general adoption of minimally invasive access have enabled more complex gastrointestinal procedures to be performed in the elderly. The factors that could influence the development of this type of approach in the elderly, as well as the precautions that should be taken, should be further analyzed.
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Affiliation(s)
- S Morales-Conde
- Unidad de Cirugía Laparoscópica, Servicio de Cirugía General y Digestiva I. Hospital Universitario Virgen Macarena, Sevilla, España.
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Abstract
From its first use as a diagnostic tool, urologic laparoscopy has developed into a complex therapy for both benign and malignant disease. Most procedures are still performed at large centers with experienced laparoscopists but nonacademic urologists are starting to gain the necessary training and skills. With the clear advantage that laparoscopy shows over open procedures in terms of decreased perioperative morbidity and quicker recovery times, patients are increasingly asking for this approach. The urologic community must meet this challenge and train future urologists to meet the expected demand.
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Affiliation(s)
- Grant D Taylor
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
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Schachtrupp A, Graf J, Tons C, Hoer J, Fackeldey V, Schumpelick V. Intravascular volume depletion in a 24-hour porcine model of intra-abdominal hypertension. ACTA ACUST UNITED AC 2003; 55:734-40. [PMID: 14566131 DOI: 10.1097/01.ta.0000042020.09010.d7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of the study was to examine hemodynamic parameters and intravascular volume in a porcine model in the presence of intra-abdominal hypertension (IAH) lasting for 24 hours. METHODS Twelve pigs (52.5 +/- 4.9 kg) were studied over a period of 24 hours. In six animals, the intra-abdominal pressure was increased to 30 mm Hg via carbon dioxide-pneumoperitoneum. The others served as controls. Using the double-indicator dilution technique, intrathoracic blood volume (ITBV), total circulating blood volume, and cardiac output (CO) were measured. Standard parameters (e.g., central venous pressure [CVP]), were also recorded. RESULTS In the presence of IAH, ITBV and total circulating blood volume were significantly reduced to 55% and 67% of control values. CO decreased to 27% and CVP increased fourfold. CONCLUSION IAH leads to significant intravascular volume depletion that is not reflected by the CVP. Assessment of CO and ITBV in the presence of a critically increased intra-abdominal pressure is therefore recommended.
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Affiliation(s)
- Alexander Schachtrupp
- Department of Surgery, Rhenish-Westphalian Technical University of Aachen, Aachen, Germany.
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Pessaux P, Regenet N, Tuech JJ, Rouge C, Bergamaschi R, Arnaud JP. Laparoscopic versus open cholecystectomy: a prospective comparative study in the elderly with acute cholecystitis. Surg Laparosc Endosc Percutan Tech 2001; 11:252-5. [PMID: 11525370 DOI: 10.1097/00129689-200108000-00005] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this prospective comparative study was to determine the feasibility and the efficacy of laparoscopic cholecystectomy for acute cholecystitis in patients older than 75 years of age and to compare the results with those of open cholecystectomy. From January 1992 to December 1999, 139 patients older than 75 years of age underwent cholecystectomy for acute cholecystitis. The two groups of patients with cholecystolithiasis included 50 patients who underwent laparoscopic cholecystectomy (group 1) and 89 patients who underwent open cholecystectomy (group 2). Group 1 consisted of 30 women and 20 men, with a mean age of 81.9 years (range, 75-98). Group 2 consisted of 51 women and 38 men, with a mean age of 81.9 years (range, 75-93). There was no difference in the American Society of Anesthesiologists classification in both groups. The length of the surgery (103.3 vs. 149.7 minutes), postoperative length of stay (7.7 vs. 12.7 days), and inpatient rehabilitation (15 vs. 42 patients) were significantly shorter in group 1 than in group 2. The postoperative morbidity rate was not different between the groups. There was no mortality in group 1, but four patients died in group 2 (P = 0.29). The conversion rate was 32% (n = 16) in group 1. In summary, laparoscopic cholecystectomy in elderly patients with acute cholecystitis is safe and effective. Laparoscopic cholecystectomy in elderly patients restores them to the best possible quality of life with the lowest cost to them physiologically.
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Affiliation(s)
- P Pessaux
- Department of Visceral Surgery, CHU-Angers, France.
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O'Malley C, Cunningham AJ. Physiologic changes during laparoscopy. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:1-19. [PMID: 11244911 DOI: 10.1016/s0889-8537(05)70208-x] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The short-term benefits of minimal access techniques include less pain, early mobilization, and shorter hospital stay. Nonetheless, significant data have accumulated regarding the complications associated with laparoscopic techniques, including those that are unique to laparoscopic surgery such as bile duct injury and disruption of major blood vessels. Other problems such as myocardial ischemia and respiratory acidosis are associated with the cardiopulmonary effects of pneumoperitoneum and systemic CO2 absorption. These physiologic changes, although tolerated by healthy patients, could have particular adverse consequences for infirm and critically ill patients. It would appear that minimizing IAP during insufflation decreases the risk of potentially marked cardiovascular changes and regional blood flow alterations. In turn, this could arguably decrease the risk of perioperative myocardial events, or organ dysfunction or failure. Laparoscopy in the critically ill patient is questionable because the role is not established. An ICU patient has little to gain from the benefits of early mobilization. Conversely, in the presence of raised ICP or borderline organ function, the physiologic changes associated with pneumoperitoneum and laparoscopy could have profound detrimental effects.
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Affiliation(s)
- C O'Malley
- Department of Anaesthesia, Beaumont Hospital/Royal College of Surgeons, Ireland, Beaumont Hospital, Dublin, Ireland
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General Principles of Minimally Invasive Surgery. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gianetta E, Cuneo S, Vitale B, Camerini G, Marini P, Stella M. Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital. Ann Surg 2000; 231:132-6. [PMID: 10636113 PMCID: PMC1420977 DOI: 10.1097/00000658-200001000-00019] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe a 7-year experience with recurrent inguinal hernia repair performed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectiveness of this method of treatment. METHODS One hundred forty-five elective and 1 emergency herniorrhaphies for recurrent groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30-89). Concomitant medical and surgical problems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurrence. A traditional hernioplasty had been previously performed in the vast majority of cases (136). Tension-free mesh or plug techniques through an anterior approach under local anesthesia were performed in 144 reoperations. Preperitoneal mesh repair and general or spinal anesthesia were used in all but one case when herniorrhaphy was performed during simultaneous operations. RESULTS Mean hospital stay after surgery was 1.5 days (range 3 hours-14 days). No perioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Local complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was postoperative neuralgia or chronic pain reported. Two re-recurrences occurred. CONCLUSIONS Given the low complication rate in this and other reported series and the absence of surgical or general complications described after preperitoneal open or laparoscopic repair and after general and spinal anesthesia, anterior mesh repair under local anesthesia seems to be a low-cost surgical technique that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias.
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Affiliation(s)
- E Gianetta
- Department of Surgery, University of Genoa School of Medicine, Italy
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Abstract
The improved technical sophistication of laparoscopy offers an attractive highly accurate diagnostic modality at the bedside for critically ill patients who are confined to the ICU and intensive monitoring unit and who are in need of timely abdominal evaluation. If the surgeon understands the physiologic effects of peritoneal insufflation and considers them during the procedure, the patient tolerates the procedure well. It is important to limit insufflation pressures and laparoscopy time. The author also recommends using the open Hasson technique. Its primary use is diagnostic in penetrating and blunt trauma and in the obscure abdomen. It has been successfully employed therapeutically for acalculous cholecystitis, abscess drainage, and correction of placement of gastrostomy tubes and peritoneal dialysis catheters. It helps avoid risky transport trips and negative or nontherapeutic laparotomy with its known associated risks.
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Affiliation(s)
- C G Rehm
- Department of Surgery, Oregon Health Sciences University, Portland, USA
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Pessaux P, Tuech JJ, Duplessis R, Seicean R, Arnaud JP. [Laparoscopic cholecystectomy after age 75]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:419-22. [PMID: 10546396 DOI: 10.1016/s0001-4001(00)80015-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY The aim of this prospective study was to determine the feasibility, complications and benefits of laparoscopic cholecystectomy in the patients over 75 years of age. METHODS From January 1992 to July 1998, among the 863 patients who underwent laparoscopic cholecystectomy, 102 patients over 75 years (group I) were compared to 761 younger patients (group II). RESULTS The conversion rate was 22% in group I versus 13% in group II (P = 0.017). Mortality and morbidity rates were respectively 1% and 13.7% in elderly patients versus 0 and 6.6% in younger patients (P = 0.009). Mean length of hospital stay was higher in group I: 6.9 versus 4.5 d in group II (P < 10(-6)). CONCLUSIONS Laparoscopic cholecystectomy is feasible in patients above 75 for the treatment of symptomatic gallstones and acute cholecystitis with a low morbidity rate.
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Affiliation(s)
- P Pessaux
- Département de chirurgie viscérale, CHU, Angers, France
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Haemodynamic effects of pneumoperitoneum in elderly patients with an increased cardiac risk. Eur J Anaesthesiol 1998. [DOI: 10.1097/00003643-199807000-00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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