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Minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas

World Journal of Clinical Cases 2021年第35期9卷 10919-10926页

作者： Duo-Ji Suo Lang Yang-Zhen Ci Ren Zha-Xi Bian Ba Department of General Surgery People’s Hospital of Tibet Autonomous RegionLasa 850000Tibet Autonomous RegionChina Department of Internal Medicine The Tibet Autonomous Region Centers for Disease Control and PreventionLasa 850000Tibet Autonomous RegionChina

BACKGROUND Colon cancer is associated with a higher incidence among residents in highaltitude *** environment at high altitudes inhibits the phagocytic and oxygen-dependent killing function of phagocytes,thereby increasing the inflammatory factors,inhibiting the body’s innate immunity and increasing the risk of colon *** To examine the effect of minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude *** Ninety-two patients with colon cancer in our hospital from January 2019 to February 2021 were selected and divided into the minimally invasive surgery and laparotomy groups using the random number table method,with 46 patients in each *** invasive surgery was performed in the minimally invasive group and laparotomy in the laparotomy *** conditions,inflammatory index pre-and post-surgery,immune function index and complication probability were *** Operative duration was significantly longer and intraoperative blood loss and recovery time of gastrointestinal function were significantly less(all Plaparotomy *** number of lymph nodes dissected was not significantly *** surgery,there were no significant differences in serum C-reactive protein,interleukin-6 and tumor necrosis factor-αlevels between the groups,whereas after surgery,the levels were significantly higher in the minimally invasive group(26.98±6.91 mg/L,146.38±11.23 ng/mL and 83.51±8.69 pg/mL vs 41.15±8.39 mg/L,186.79±15.36 ng/mL and 110.65±12.84 pg/mL,respectively,P<0.05).Furthermore,before surgery,there were no significant differences in CD3+,CD4+and CD4+/CD8+levels between the groups,whereas after surgery,the levels decreased in both groups,being significantly higher in the minimally invasive group(55.61%±4.39%,35.45%±3.67%and 1.30±0.35 vs 49.68%±5.33%,31.21%±3.25%and 1.13±0.30,respectively,P<0.05).Complication probability was significant

关键词： Minimally invasive surgery laparotomy High-altitude area Colon cancer Surgical trauma Immune dysfunction

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Comparative analysis of APACHE-Ⅱ and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

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World Journal of Clinical Cases 2019年第16期7卷 2227-2237页

作者： Deb Sanjay Nag Ankur Dembla Pratap Rudra Mahanty Shashi Kant Abhishek Chatterjee Devi Prasad Samaddar Parul Chugh Department of Anaesthesiology and Critical Care Tata Main HospitalJamshedpur 831001India Department of Anaesthesiology and Critical Care Darya Ram HospitalSonipat 131001India Department of Biomedical Statistics Sir Ganga Ram HospitalNew Delhi 110060India

BACKGROUND laparotomy remains one of the commonest emergency surgical *** prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity(P-POSSUM) and the acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare *** To compare the ability of APACHE-Ⅱ and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency *** All patients undergoing emergency laparotomy at the Tata Main Hospital,Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-Ⅱ scoring were done, and the outcome analysis evaluated with mortality being the primary *** For P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-Ⅱ, at the cut off value of 24, the area under the curve was *** Because the ability of APACHE-Ⅱ to predict mortality was similar to P-POSSUM and APACHE-Ⅱ does not need scoring for intra-operative findings and histopathology reports, APACHE-Ⅱ can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes,either of the two scoring systems can be used.

关键词： laparotomy Emergencies Acute physiology and chronic health evaluation Ⅱ Morbidity Mortality

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Post-laparotomy heterotopic ossification of the xiphoid process: A case report

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World Journal of Clinical Cases 2023年第36期11卷 8568-8573页

作者： Seung Soo Lee Department of Surgery Kyungpook National University HospitalDaegu 41944South Korea Department of Surgery School of MedicineKyungpook National UniversityDaegu 41944South Korea

BACKGROUND Heterotopic ossification(HO)represents all types of extraskeletal ossification in the *** occurs in various areas,including the skin,subcutaneous tissue,muscle,and *** excision is recommended for symptomatic *** radiotherapy,oral nonsteroidal anti-inflammatory drugs,and topical sealants,such as bone wax,have been recommended as preventive *** HO is rare in occurrence,these recommendations are based on personal experiences,and there is a lack of information on individualized treatments depending on its *** SUMMARY A 62-year-old male was admitted for symptomatic HO along a laparotomy *** excision was performed for an 11 cm-sized ossification originating from the xiphoid process,and bone wax was applied to the excisional ***,the surgical wound failed to *** several weeks of saline-soaked gauze dressing,delayed wound closure was *** patient was finally discharged eight weeks after the *** HO can occur in various areas of the body,a treatment strategy that may be effective for some may not be for *** wax has been used as a topical sealant over excisional margins in the shoulder,elbow,and temporomandibular ***,in our case,its application on an abdominal surgical wound delayed its primary healing *** valuable lesson was that,when choosing a treatment method for HO based on available research data,its location must be *** Complete excision should be the priority treatment option for symptomatic HO along the laparotomy *** wax application is not *** Tip:Heterotopic ossification(HO)represents all types of extraskeletal ossification,and occurs in various areas,including the skin,muscle,and *** are some suggested treatment and preventive approaches for symptomatic HO,which include surgical excision and preventive measures such as postoperative radiotherapy,oral nonsteroidal anti-inflam-matory drug

关键词： Heterotopic ossification Joints laparotomy Waxes Wound healing Case report

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A comparative analysis of spontaneous fertility after myomectomy by laparotomy associated or not with a“second look”laparoscopy

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Laparoscopic, Endoscopic and Robotic Surgery 2019年第2期2卷 27-30页

作者： Etienne Belinga Daniel Antony Bikak Djima Bruno Ela Ondo Esther Juliette Ngo Um Meka Emile Telesphore Mboudou Pascal Foumane Department of Obstetrics and Gynecology Faculty of Medicine and Biomedical Sciencesthe University of Yaounde ICameroon Higher Institute of Health Sciences University of the MountainsCameroon Department of Epidemiology Higher Institute of Health SciencesUniversity of the MountainsCameroon

Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our *** aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did ***:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did ***,data was collected from the records of patients included in the ***,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility ***:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.

关键词： Myomectomy laparotomy Infertility Adhesions “Second look”laparoscopy

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Comparison of two different laparotomy methods for modeling rabbit VX2 hepatocarcinoma

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World Journal of Gastroenterology 2015年第16期21卷 4875-4882页

作者： Zhu Chen Zhen Kang En-Hua Xiao Min Tong Yu-Dong Xiao Hua-Bing Li Department of Radiology the Second Xiangya HospitalCentral South University Experimental Animal Center the Second Xiangya HospitalCentral South University

AIM:To compare two different laparotomy methods for modeling rabbit VX2 ***:Thirty New Zealand rabbits were randomly divided into two groups:A and *** A was assigned a traditional laparotomy method(embedding tumor fragments directly into the liver with tweezers).Group B was subjected to an improved laparotomy method(injection of tumor fragments into the liver through a 15 G syringe needle).The operation time, incision length, incision infection rate, and mortality rate were compared between the two groups after *** resonance imaging(MRI) was performed to evaluate tumor formation rates and the characteristics of the tumors 2 wk after ***:The mean operation times for the two groups(Group A vs Group B) were 23.2 ± 3.4 min vs 17.5 ± 2.9 min(P 0.05), whichwere not significantly *** performed after 2weeks showed that the tumor formation rates in the two groups were 90.9%vs 93.3%(P>0.05).These rates were not significantly different between the two *** celiac implantation rate and abdominal wall metastasis rate in the two groups were 36.4%vs 13.3%(P<0.05)and 27.2%vs 6.7%(P<0.05),respectively,which were significantly different between the two ***:The tumor formation rates were not significantly different between the two methods for modeling rabbit VX2 ***,the improved method is recommended because it has certain advantages.

关键词： Rabbit VX2 hepatocarcinoma laparotomy Modeling Magnetic resonance imaging

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Closure of the Equine Nephrosplenic Space Using a Single LED Powered Trocar via Standing Mini-laparotomy

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Open Journal of Veterinary Medicine 2019年第2期9卷 11-20页

作者： Christian Bussy Kossay Benredouane Juan Munoz Diane Petat Clinique Vétérinaire du Grand Renaud Saint Saturnin France The Department of Surgery Universidad Alfonso X el Sabio Madrid Spain

Objective: To evaluate a technique using a custom-developed LED powered Single Port Trocar for closure of the nephrosplenic space via a standing mini-laparotomy. Design: Prospective case series. Animals: 60 client-owned horses with a history of nephrosplenic entrapment. Procedures: The nephrosplenic space was closed under direct visualization through a specifically designed LED powered Single Port Trocar in standing sedated horses having experienced recurrence or previous surgical correction of a nephrosplenic entrapment. Obliteration of the space was performed in a cranial to caudal direction in a simple continuous fashion. Time required for suturing the nephrosplenic space, as well as per and post-operative complications were recorded. Clients and referring veterinarians were asked to communicate any complication that occurred after discharge. Results: Surgical time ranged from 23 to 45 min. No complication except for self-limited spleen capsule bleeding occurred during the procedure. Minor wound discharge was noted in 2 cases, and another 2 horses developed post-surgical sweating patches close to the incision. All horses were allowed to progressively resume exercise, starting 1 month post discharge from the hospital. Cosmetic results were considered satisfactory and no recurrence of left dorsal displacement of the colon was reported post-surgery. Conclusions and clinical relevance: A Single Port LED powered Trocar is a technique that allows effective, fast, and safe closure of the nephrosplenic space in the standing horse with minimal instrumentation.

关键词： Colic Colon Nephrosplenic Entrapment laparotomy

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Emergency laparotomy in octogenarians: A 5-year study of morbidity and mortality

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World Journal of Gastrointestinal Surgery 2013年第7期5卷 216-221页

作者： Gemma Green Irshad Shaikh Roland Fernandes Henk Wegstapel Department of Colorectal Surgery Medway Maritime HospitalGillingham ME7 5NY United Kingdom

AIM: To determine the morbidity and mortality associated with emergency laparotomy for a clinically acute abdomen in patients aged ≥ 80 years. METHODS: In this retrospective audit, octogenarians undergoing emergency laparotomy between 1st January 2005 and 1 st January 2010 were identified using the Galaxy Theatre System. Patients undergoing abdominal surgery through groin crease incisions or Lanz or Gridiron incisions were excluded. Also simple appendectomies were excluded. All patients were aged 80 years or more at the time of their surgery. Data were obtained using casenote review with a standardised proforma to determine patient age, American Society of Anesthesiologists (ASA) grade, indications for surgery, early (within 30 d) and late (after 30 d) complications, mortality and length of stay. Data were inserted into a Microsoft Excel spreadsheet and analysed. RESULTS: One hundred patients were identified from the database (Galaxy) as having undergone emergency laparotomy. Of those, 55 underwent the procedure for intestinal procedures and 37 for secondary *** was a 2:1 female predominance; average age 85 and ASA grade 3. Bowel resection was required in 51 out of the 100 patients and 22 (43%) died. Other procedures included appendicectomy, adhesiolysis, repair of AAA graft leak and colostomies for the pathological process resulting in an acute abdomen. Twelve of 100 patients (12%) suffered intra-operative complications, including splenic and bowel-serosal tears. Seventy patients (70%) had postoperative complications including myocardial infarction, wound infection, haematoma and sepsis. Overall mortality was 45/100 patients (45%). The major causes of death were sepsis (19/45 patients, 42%), underlying cancer (13/45 patients, 29%); with others including bowel obstruction (2/45 patients, 4%), myocardial and intestinal ischaemia and dementia. CONCLUSION: Emergency laparotomy in octogenarians carries a significant morbidity and mortality. In particular,

关键词： laparotomy Perioperative care Aged Mortality Morbidity

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Clinico-Demographic Characteristics of Intestinal Tuberculosis in Pre-Operative Unsuspected laparotomy as Incidental Findings in Bangladesh

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Journal of Tuberculosis Research 2017年第2期5卷 139-145页

作者： Md. Mizanur Rahman Ayub Ali Md. Abdullah Yusuf Md. Zamil Zaidur Rahim Md. Mahfuzur Rahman Zahir-ul Islam Gafargaon Upazilla Health Complex Mymensingh Bangladesh Shadar General Hospital Cox’s Bazar Bangladesh Department of Microbiology National Institute of Neurosciences & Hospital Dhaka Bangladesh Department of Orthopedics Combined Military Hospital Comilla Bangladesh Department of Neurosurgery National Institute of Neurosciences & Hospital Dhaka Bangladesh Railway General Hospital Dhaka Bangladesh

Background: Clinical presentation of intestinal tuberculosis is varied. It is also essential to know the clinical and demographic characteristics of incidentally detected intestinal tuberculosis patient. Objective: The purpose of the present study was to find out the clinic-demographic characteristics of intestinal tuberculosis in clinically and preoperatively unsuspected laparotomies. Methodology: This cross-sectional study was carried out in the Department of Surgery at Dhaka Medical College Hospital, Dhaka from March 2002 to March 2004 for a period of two (2) years. All the patients underwent laparotomy presented without any suspicion of pulmonary or intestinal tuberculosis were included as study population. Patients who were without the history of cough, haemoptysis, antitubercular drug therapy were included. Per operative suspicion was raised due to enlarged lymph nodes in mesentery, omental masses, ileocaecal masses, suspicious growth in ileum, omental thickening, perforation suspected by tuberculosis. Biopsy was taken from suspicious lesions. Histopathology was confirmed the tubercular lesion. Results: A total number of 300 patients under laparotomy were recruited for this study of which 38 positive cases were found in the study with a percentage of 12.7%. Maximum affected age group was 21 to 30 years which was 16 (42%) cases. Male was predominant to female which was 28 (73.7%) cases and 10 (26.3%) cases respectively. Low socioeconomic people are affected more (76.3%). Most common presentation in positive cases was acute and sub-acute intestinal obstruction 20 (52.6%) followed by intestinal perforation (26.31%). Conclusion: In conclusion young age male patient is the most commonly affected intestinal tuberculosis which is frequently presented with sub-acute intestinal obstruction among the preoperatively unsuspected laparotomy patients.

关键词： Intestinal Tuberculosis Unsuspected laparotomy Clinic-Demographic Characteristics

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Outcomes of Layered versus Mass Closure in Transverse Incision during Emergency laparotomy in Children

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Journal of Biosciences and Medicines 2020年第8期8卷 180-193页

作者： Khandoker Moynul Hasan Shahnoor Islam Md. Ashraf Ul Huq Muhammed Moinul Huque Shah Md. Rezaul Karim Mohammad Shafiul Azam Md. Iqbal Hossain Talukder Sharmin Ara Begum Mohammad Kamrul Ahsan A. K. M. Shahidur Rahman Department of Pediatric Surgery Dhaka Medical College Hospital (DMCH) Dhaka Bangladesh Department of Pediatric Urology Dhaka Medical College Hospital (DMCH) Dhaka Bangladesh Department of Surgery Sheikh Hasina Medical College Hospital Habiganj Bangladesh Department of Urology National Institute of Kidney Diseases and Urology (NIKDU) Dhaka Bangladesh Department of Surgery Sheikh Hasina Medical College Hospital Tangail Bangladesh Department of Anesthesiology National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) Dhaka Bangladesh Holy Family Red Crescent Medical College Hospital (HFRCMCH) Dhaka Bangladesh Department of Nephrology Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka Bangladesh

Background: The value of laparotomy closure technique may be measured by the incidence of early and late wound complications. The best laparotomy closure technique should be less time consuming, easy and cost-effective, while preventing both early and late complications. Objective: To compare the outcomes of layered versus mass closure in transverse incision during emergency laparotomy in children. Methods: This prospective comparative study was conducted at Department of Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2016 to June 2018. A total of 60 pediatric age cases that underwent laparotomy were included in this study. Cases were randomly allocated into two groups;30 patients were in Group A (Layered closure) and 30 patients were in Group B (Mass closure). The outcome variables were time required for wound closure, wound infection, wound dehiscence and incisional hernia. Data were analyzed and compared by statistical tests. Results: The mean age of Group A and Group B patients were 31.08 ± 30.25 months and 34.70 ± 42.73 months respectively (p = 0.706). The ratio between male and female subject was 1.1:1 in Group A and 3.3:1 in Group B. The common diseases of the study patients who underwent laparotomy were intussusceptions, intestinal obstruction due to bands and adhesion, perforated appendix and perforation of small intestine due to blunt trauma respectively. Mean wound closure time was significantly less in mass closure group [28.20 ± 2.17 minutes in layered closure group and 18.80 ± 1.67 minutes in mass closure group, (p ≤ 0.001)]. Wound infection rate, incidence of superficial wound dehiscence, and incisional hernia were relatively less in mass closure group, however, the differences were not statistically significant (p = 0.053, p = 0.095 and p = 0.301 respectively). There was no complete wound dehiscence in Group A, but that was in 1 (3.3%) patient i

关键词： laparotomy Layered Closure Mass Closure

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Delay for Performing laparotomy for Extra Uterine Pregnancy in N’Djamena Mother and Child University Hospital

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Open Journal of Obstetrics and Gynecology 2024年第4期14卷 520-527页

作者： Gabkika Bray Madoué Saleh Abdelsalam Khadidja Mahayadine Salah Serfeurbe Pefah Foumsou Lhagadang Faculty of Human Health Sciences of N’ Djamena N&#8217Djamena Chad N’ Djamena Mother and Child University Hospital N&#8217Djamena Chad

Background: Ectopic pregnancy is defined as any pregnancy developed outside the uterine cavity. Objective: to study the relationship between the duration of laparotomy for EP and maternal prognosis. Patients and method. This was a prospective analytical study performed during a period of six (06) months, from May 1st to October 30, 2023, on delay time to perform laparotomy for EP in N’Djamena Mother and child University hospital (NMCUH). We included in this series all patients admitted for EP managed by laparotomy. Data were collected using Word software and analyzed using SPSS 18.0 version 2018. The p value statistical test was used to compare variables (p significant if ≤5%). Results: We recorded 92 cases of EP out of 5751 pregnancies, giving a frequency of 1.6%. Among patients diagnosed with EP, 76/92 (82.6%) had an indication of laparotomy. In 90.8%, the EP was ruptured. On admission, the diagnosis of EP was made within 1 hour in 15.8% of cases. The time to sign the consent allowing doctor to operate was >1 hour in 14.5% of cases. The operating room was unavailable in 34.2% of cases, with an unavailability of >1 hour in 17.1% of cases. Total salpingectomy was performed in 93.4%. Salpingotomy was performed in 6.6%. The lethality rate was 3.9% with significant value when the delay after indication and admission in the operating room is >1 (p value = 0.03). Conclusion: Various factors, such as the search for blood products, the time loss to sign the consent form and the unavailability of the operating room, delay the laparotomy, influence maternal prognosis. Anticipation on these factors is necessary in order to limit the proportion of delays.

关键词： Delay laparotomy NMCUH Chad

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