1
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Hang D, Chandrashekarappa K, Schilling K, Ubert A, de Oliveira N, Pagel PS. A two-circuit strategy for intraoperative extracorporeal support during single lung transplantation in a patient bridged with venovenous extracorporeal membrane oxygenation. Perfusion 2024; 39:281-284. [PMID: 36301682 DOI: 10.1177/02676591221137471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Venovenous extracorporeal membrane oxygenation is increasingly used as a bridging strategy in decompensating patients awaiting lung transplantation. Various approaches for continuing support intraoperatively have been previously described. A two-circuit strategy that uses the in situ venovenous extracorporeal membrane oxygenation circuit supplemented with peripheral cardiopulmonary bypass allows for diversion of native cardiac output away from the transplanted lung as well as seamless continuation of venovenous extracorporeal membrane oxygenation postoperatively.
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Affiliation(s)
- Dustin Hang
- Medical College of Wisconsin Department of Anesthesiology, Milwaukee, WI, USA
| | | | - Kyle Schilling
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adam Ubert
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nilto de Oliveira
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Paul S Pagel
- Anesthesiology, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA
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2
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Kamalia MA, Carlson SF, Melamed J, Ubert A, Rossi PJ, Durham LA. Adhered ECMO cannula in COVID-19 related severe acute respiratory failure. J Cardiothorac Surg 2022; 17:263. [PMID: 36209244 PMCID: PMC9547677 DOI: 10.1186/s13019-022-02004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Crescent cannula adhesion in the setting of COVID-19 respiratory failure requiring extracorporeal membrane oxygenation (ECMO) support is a novel complication. The objective of this case presentation is to highlight this rare complication and to explore potential predisposing factors and our management strategies. Case presentation We present the case of a 25 y.o. patient with COVID-19 respiratory failure requiring ECMO support for 16-days in which a 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein. Attempts to remove the cannula at the bedside failed due to immobility of the cannula. Ultrasound of the right neck was unremarkable, so he was taken to the hybrid OR where both TEE and fluoroscopy were unrevealing. An upper sternotomy was performed, and the superior vena cava and proximal jugular vein were dissected revealing a 2 cm segment of the distal SVC and proximal jugular vein that was densely sclerosed and adherent to the cannula. The vessel was opened across the adherent area at the level of the innominate vein and the cannula was then able to be withdrawn. The patient suffered no ill effects and had an unremarkable recovery to discharge. Conclusions To date, there have been no reports of crescent cannula adhesion related complications. In patients with COVID-19 respiratory failure requiring ECMO, clinicians should be aware of widespread hypercoagulability and the potential of unprovoked, localized venous sclerosis and cannula adhesion. We report our technique of decannulation in the setting of cannula adhesion and hope that presentation will shed further light on this complication allowing clinicians to optimize patient care.
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Affiliation(s)
| | | | - Joshua Melamed
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, HUB for Collaborative Medicine, 5th Floor, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
| | - Adam Ubert
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, HUB for Collaborative Medicine, 5th Floor, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Peter J Rossi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, HUB for Collaborative Medicine, 5th Floor, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
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3
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Affiliation(s)
- Brent Hanson
- Department of Surgery West Virginia University School of Medicine Charleston Division Charleston, West Virginia
| | - Adam Ubert
- Department of Surgery West Virginia University School of Medicine Charleston Division Charleston, West Virginia
| | - Benjamin Dyer
- Department of Surgery West Virginia University School of Medicine Charleston Division Charleston, West Virginia
| | - Bryan Richmond
- Department of Surgery West Virginia University School of Medicine Charleston Division Charleston, West Virginia
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4
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Richmond B, Ubert A, Judhan R, King J, Harrah T, Dyer B, Thompson S. Component Separation with Porcine Acellular Dermal Reinforcement is Superior to Traditional Bridged Mesh Repairs in the Open Repair of Significant Midline Ventral Hernia Defects. Am Surg 2020. [DOI: 10.1177/000313481408000818] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The optimal technique for complex ventral hernia repair (VHR) remains controversial. Component separation (CS) reinforced with porcine acellular dermal matrix (PADM) has shown favorable results compared with series of conventional bridged VHR, but few comparative studies exist. We conducted a retrospective cohort study comparing 40 randomly selected patients who underwent CS/PADM reinforcement against an identical number of patients who underwent conventional open VHR with mesh at our institution. Patient characteristics, operative findings, outcomes, complications, reoperations, and recurrences were obtained by chart review. Fisher's exact/ t test compared outcomes between the two cohorts. Statistical significance was set as P < 0.05. Mean follow-up was 33.1 months. Patient groups did not differ significantly in race ( P = 1.00), age ( P = 0.82), body mass index ( P = 0.14), or comorbid conditions (smoking, chronic obstructive pulmonary disease, obesity, steroid use; P values 0.60, 0.29, 0.08, and 0.56, respectively). Defect size was greater in the CS/PADM group (mean, 372.5 vs 283.7 cm2, P = 0.01) as was the percentage Ventral Hernia Working Group Grade III/IV hernias (65.0 vs 30.0%, P = 0.03). Recurrences were lower in the CS/PADM group (13.2 vs 37.5%, P = 0.02). Mesh infection was lower in the CS/PADM group (0 vs 23% in the bridged group, P = 0.002), all of which occurred with synthetic mesh. Indications for reoperation (recurrence or complications requiring reoperation) were also lower in the CS/PADM group (17.5 vs 52.5%, P = 0.002). Superior results are achieved with CS/PADM reinforcement over traditional bridged VHR. This is evidenced by lower recurrence rates and overall complications requiring reoperation, particularly mesh infection. This is despite the greater use of CS in larger defects and contaminated hernias (VHWG Grade III and IV). CS/PADM reinforcement should be strongly considered for the repair of significant midline ventral hernia defects.
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Affiliation(s)
- Bryan Richmond
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Adam Ubert
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Rudy Judhan
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Jonathan King
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Tanner Harrah
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
| | - Benjamin Dyer
- Department of Surgery, West Virginia University, Charleston, West Virginia
| | - Stephanie Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
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5
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Richmond BK, Judhan R, Chong B, Ubert A, Aburahma Z, Mangano W, Thompson S. False-negative Results with the Bethesda System of Reporting Thyroid Cytopathology: Predictors of Malignancy in Thyroid Nodules Classified as Benign by Cytopathologic Evaluation. Am Surg 2020. [DOI: 10.1177/000313481408000834] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The benign category of the Bethesda System for reporting thyroid cytopathology (BSRTC) predicts an incidence of malignancy from zero to three per cent. However, recent series report higher rates of malignancy ranging from eight to 14 per cent. Surgery is often performed for reasons other than their fine needle aspiration biopsy (FNAB) such as symptoms, nodule enlargement, or worrisome imaging. We hypothesized that an analysis of patients who underwent thyroidectomy despite a benign FNAB would identify predictors of malignancy, an area not currently addressed by American Thyroid Association guidelines. We performed a retrospective analysis of patients with benign FNAB results who underwent thyroidectomy from October 2007 to October 2012. Data collected included symptoms, imaging findings, FNAB results, and operative and histopathology results, all of which were obtained by chart review. Findings were compared between patients with and without a diagnosis of malignancy. Statistical significance was set as P < 0.05. Of 3839 FNABs, 2838 were benign. Of these, 180 underwent surgery for indications other than the FNAB category. Twenty-four (13.4%) malignancies were identified: 12 (6.7%) incidental microcarcinomas and 12 (6.7%) significant cancers (papillary greater than 1.0 cm, any nonpapillary histology). No patient's symptoms or signs reached significance as a predictor of malignancy. Suspicious ultrasound appearance was significantly associated with an underlying carcinoma ( P = 0.004). The false-negative result with benign FNAB is higher in surgical series than suggested by the BSRTC. Patients with tolerable symptoms may be observed in the face of a benign FNAB. Additionally, despite a benign FNAB, recommendations for closer follow-up or surgical intervention are warranted if the ultrasound appearance is suspicious.
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Affiliation(s)
- Bryan K. Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia; the
| | - Rudy Judhan
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia; the
| | - Benny Chong
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia; the
| | - Adam Ubert
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia; the
| | - Zachary Aburahma
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia; the
| | - William Mangano
- Department of Pathology, Charleston Area Medical Center, Charleston, West Virginia
| | - Stephanie Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
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6
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Rogers MP, Reskin SM, Ubert A, Black MC, Grubb KJ. Hybrid Endovascular Aortic Arch Reconstruction for Acute Aortic Dissection: An Endovascular Bridge Technique for Complex Anatomy. Vasc Endovascular Surg 2017; 52:143-147. [PMID: 29237361 DOI: 10.1177/1538574417747037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute type A aortic dissections starting at the arch pose a challenge for cardiac surgeons. Open surgical repair requires deep hypothermic circulatory arrest for arch reconstruction and is associated with significant morbidity and mortality. Hybrid aortic repair techniques, with open arch debranching and thoracic endovascular aortic repair, have been employed in high-risk cases and challenging aortic pathology. Herein, we present a case of a 33-year-old African American male with a history of open thoracoabdominal aortic reconstruction and femoral-femoral artery bypass for a type B dissection who subsequently presented with new-onset chest pain and was found to have a retrograde type A dissection of a bovine arch with multiple dissection flaps and possible contrast extravasation on chest computed tomography. Endovascular reconstruction of the aortic arch using a hybrid technique was utilized and proved to be feasible and further should be considered when complex anatomy limits traditional surgical options.
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Affiliation(s)
- Michael P Rogers
- 1 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sophie M Reskin
- 1 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Adam Ubert
- 1 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Matthew C Black
- 1 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kendra J Grubb
- 1 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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7
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Richmond BK, O'Brien B, Ubert A, Thompson S. Current Treatment Guidelines for Postoperative Surgical Site Infection: Clinical Considerations in the Surgical Care Improvement Project Era. Am Surg 2015. [DOI: 10.1177/000313481508100416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bryan K. Richmond
- Department of Surgery West Virginia University/Charleston Division Charleston, West Virginia
| | - Bridget O'Brien
- Department of Surgery West Virginia University/Charleston Division Charleston, West Virginia
| | - Adam Ubert
- Department of Surgery West Virginia University/Charleston Division Charleston, West Virginia
| | - Stephanie Thompson
- Department of Surgery West Virginia University/Charleston Division Charleston, West Virginia
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8
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Richmond BK, O'Brien B, Ubert A, Thompson S. Current treatment guidelines for postoperative surgical site infection: clinical considerations in the surgical care improvement project era. Am Surg 2015; 81:E179-E180. [PMID: 25831172 PMCID: PMC4659500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Bryan K Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia, USA
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9
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Richmond BK, Judhan R, Chong B, Ubert A, Aburahma Z, Mangano W, Thompson S. False-negative results with the Bethesda System of reporting thyroid cytopathology: predictors of malignancy in thyroid nodules classified as benign by cytopathologic evaluation. Am Surg 2014; 80:811-816. [PMID: 25105404 PMCID: PMC4476287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The benign category of the Bethesda System for reporting thyroid cytopathology (BSRTC) predicts an incidence of malignancy from zero to three per cent. However, recent series report higher rates of malignancy ranging from eight to 14 per cent. Surgery is often performed for reasons other than their fine needle aspiration biopsy (FNAB) such as symptoms, nodule enlargement, or worrisome imaging. We hypothesized that an analysis of patients who underwent thyroidectomy despite a benign FNAB would identify predictors of malignancy, an area not currently addressed by American Thyroid Association guidelines. We performed a retrospective analysis of patients with benign FNAB results who underwent thyroidectomy from October 2007 to October 2012. Data collected included symptoms, imaging findings, FNAB results, and operative and histopathology results, all of which were obtained by chart review. Findings were compared between patients with and without a diagnosis of malignancy. Statistical significance was set as P < 0.05. Of 3839 FNABs, 2838 were benign. Of these, 180 underwent surgery for indications other than the FNAB category. Twenty-four (13.4%) malignancies were identified: 12 (6.7%) incidental microcarcinomas and 12 (6.7%) significant cancers (papillary greater than 1.0 cm, any nonpapillary histology). No patient's symptoms or signs reached significance as a predictor of malignancy. Suspicious ultrasound appearance was significantly associated with an underlying carcinoma (P = 0.004). The false-negative result with benign FNAB is higher in surgical series than suggested by the BSRTC. Patients with tolerable symptoms may be observed in the face of a benign FNAB. Additionally, despite a benign FNAB, recommendations for closer follow-up or surgical intervention are warranted if the ultrasound appearance is suspicious.
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Affiliation(s)
- Bryan K. Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia
| | - Rudy Judhan
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia
| | - Benny Chong
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia
| | - Adam Ubert
- Department of Surgery, West Virginia University/Charleston Division, Charleston West Virginia
| | - Zachary Aburahma
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia
| | - William Mangano
- Department of Pathology, Charleston Area Medical Center, Charleston, West Virginia
| | - Stephanie Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
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10
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Richmond B, Ubert A, Judhan R, King J, Harrah T, Dyer B, Thompson S. Component separation with porcine acellular dermal reinforcement is superior to traditional bridged mesh repairs in the open repair of significant midline ventral hernia defects. Am Surg 2014; 80:725-731. [PMID: 25105388 PMCID: PMC4476308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The optimal technique for complex ventral hernia repair (VHR) remains controversial. Component separation (CS) reinforced with porcine acellular dermal matrix (PADM) has shown favorable results compared with series of conventional bridged VHR, but few comparative studies exist. We conducted a retrospective cohort study comparing 40 randomly selected patients who underwent CS/PADM reinforcement against an identical number of patients who underwent conventional open VHR with mesh at our institution. Patient characteristics, operative findings, outcomes, complications, reoperations, and recurrences were obtained by chart review. Fisher's exact/t test compared outcomes between the two cohorts. Statistical significance was set as P < 0.05. Mean follow-up was 33.1 months. Patient groups did not differ significantly in race (P = 1.00), age (P = 0.82), body mass index (P = 0.14), or comorbid conditions (smoking, chronic obstructive pulmonary disease, obesity, steroid use; P values 0.60, 0.29, 0.08, and 0.56, respectively). Defect size was greater in the CS/PADM group (mean, 372.5 vs 283.7 cm(2), P = 0.01) as was the percentage Ventral Hernia Working Group Grade III/IV hernias (65.0 vs 30.0%, P = 0.03). Recurrences were lower in the CS/PADM group (13.2 vs 37.5%, P = 0.02). Mesh infection was lower in the CS/PADM group (0 vs 23% in the bridged group, P = 0.002), all of which occurred with synthetic mesh. Indications for reoperation (recurrence or complications requiring reoperation) were also lower in the CS/PADM group (17.5 vs 52.5%, P = 0.002). Superior results are achieved with CS/PADM reinforcement over traditional bridged VHR. This is evidenced by lower recurrence rates and overall complications requiring reoperation, particularly mesh infection. This is despite the greater use of CS in larger defects and contaminated hernias (VHWG Grade III and IV). CS/PADM reinforcement should be strongly considered for the repair of significant midline ventral hernia defects.
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Affiliation(s)
- Bryan Richmond
- Department of Surgery, West Virginia University, Charleston, West Virginia, USA
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11
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Hanson B, Ubert A, Dyer B, Richmond B. Adult soft tissue Ewing's sarcoma/primitive neuroectodermal tumor. Am Surg 2013; 79:E249-E250. [PMID: 23815991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Brent Hanson
- Department of Surgery, West Virginia University School of Medicine, Charleston Division, Charleston, West Virginia 25304, USA
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12
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Maxwell D, Thompson S, Richmond B, McCagg J, Ubert A. Quality of life after laparoscopic cholecystectomy for biliary dyskinesia in the pediatric population: a pilot study. Am Surg 2012; 78:111-118. [PMID: 22273327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This pilot study examined symptom relief and quality of life in pediatric patients who received laparoscopic cholecystectomy surgery at our institution for biliary dyskinesia. We used two validated questionnaires: the Child Health Questionnaire (CHQ-PF28), to assess general well-being, and the Gastrointestinal Quality of Life Index (GIQLI), to measure gastrointestinal-related health. After Institutional Review Board approval, all patients under the age of 18 years who underwent laparoscopic cholecystectomy for biliary dyskinesia between November 2006 and May 2010 received mailed questionnaires. Preoperative and postoperative data were retrospectively collected from respondents and included age, race, symptoms, gallbladder ejection fraction values, pathologic findings, and clinical course. Of 89 patients meeting inclusion criteria, 21 responded. Mean age at surgery was 13.08 years (range, 8 to 17 years). The most common preoperative symptoms consisted of nausea (100%), postprandial pain (90.5%), right upper quadrant pain (81.0%), and vomiting (66.7%). Mean long-term follow-up interval was 18.9 months (range, 7 to 40 months; SD 10.37). Patients with long-term symptom relief reported significantly higher GIQLI scores than those with enduring symptoms. Examination of the results from the CHQ-PF28 revealed significantly lower scores than a general U.S. pediatric sample in both the Physical and Psychosocial Summary Measures (P < 0.05). Children experiencing long-term symptom cessation after laparoscopic cholecystectomy reported higher quality of life than those who had incomplete or only short-term relief. However, regardless of the degree of symptom relief, the degree of quality of life experienced by our study sample of patients with biliary dyskinesia is lower than that of a comparable U.S. pediatric sample.
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Affiliation(s)
- Damian Maxwell
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia 25304, USA.
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13
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Maxwell D, Thompson S, Richmond B, McCagg J, Ubert A. Quality of Life after Laparoscopic Cholecystectomy for Biliary Dyskinesia in the Pediatric Population: A Pilot Study. Am Surg 2012. [DOI: 10.1177/000313481207800147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This pilot study examined symptom relief and quality of life in pediatric patients who received laparoscopic cholecystectomy surgery at our institution for biliary dyskinesia. We used two validated questionnaires: the Child Health Questionnaire (CHQ-PF28), to assess general well-being, and the Gastrointestinal Quality of Life Index (GIQLI), to measure gastrointestinal-related health. After Institutional Review Board approval, all patients under the age of 18 years who underwent laparoscopic cholecystectomy for biliary dyskinesia between November 2006 and May 2010 received mailed questionnaires. Preoperative and postoperative data were retrospectively collected from respondents and included age, race, symptoms, gallbladder ejection fraction values, pathologic findings, and clinical course. Of 89 patients meeting inclusion criteria, 21 responded. Mean age at surgery was 13.08 years (range, 8 to 17 years). The most common preoperative symptoms consisted of nausea (100%), postprandial pain (90.5%), right upper quadrant pain (81.0%), and vomiting (66.7%). Mean long-term follow-up interval was 18.9 months (range, 7 to 40 months; SD 10.37). Patients with long-term symptom relief reported significantly higher GIQLI scores than those with enduring symptoms. Examination of the results from the CHQ-PF28 revealed significantly lower scores than a general U.S. pediatric sample in both the Physical and Psychosocial Summary Measures ( P < 0.05). Children experiencing long-term symptom cessation after laparoscopic cholecystectomy reported higher quality of life than those who had incomplete or only short-term relief. However, regardless of the degree of symptom relief, the degree of quality of life experienced by our study sample of patients with biliary dyskinesia is lower than that of a comparable U.S. pediatric sample.
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Affiliation(s)
- Damian Maxwell
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | | | - Bryan Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | - Jillian McCagg
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
| | - Adam Ubert
- Department of Surgery, West Virginia University/Charleston Division, Charleston, West Virginia
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