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High Age Increases the Risk of Complications and Reduces Survival Following Esophagectomy for Adenocarcinoma
Daniel Willy Kjaer,
Kaare Terp Fjerderholt,
Jakob Kirkegaard,
Cecilie Okholm,
Michael Patrick Achiam,
Lars Bo Svendsen,
Frank Viborg Mortensen
Issue:
Volume 6, Issue 1, February 2018
Pages:
1-7
Received:
8 November 2017
Accepted:
16 November 2017
Published:
14 December 2017
Abstract: Introduction: The aim of the present study was to investigate the impact of high age and comorbidities in relation to postoperative complications, mortality, and long-term survival in patients undergoing surgery for adenocarcinoma of the esophagus and gastro-esophageal junction (GEJ). Methods: A cohort study of 557 patients operated for adenocarcinoma of the esophagus and GEJ. Data were collected from a prospectively maintained database, the Danish National Patient Registry, and medical records. Univariate and multivariate statistical models were used to analyze data after stratification for possible confounders. Results: The incidence of postoperative complications increased in patients aged ≥ 75 years compared with younger patients (OR: 1.57; 95% CI: 0.93-2.62) although not significant. However, testing for trend revealed a linear increase with age for severe complications (p=0.005). Age ≥ 75 years was also associated with increased 90-day but not 30-day mortality (HR: 5.05; 95% CI: 1.70-14.94 and HR: 3.47; 95% CI: 0.61-19.72 respectively). Overall survival decreased with increasing age (p=0.036). Conclusion: We found high age as an independent risk factor for death within 90 days but not 30 days after surgery for adenocarcinoma of the esophagus and GEJ. The presence of co-morbidity seemed to increase the risk for postoperative complications.
Abstract: Introduction: The aim of the present study was to investigate the impact of high age and comorbidities in relation to postoperative complications, mortality, and long-term survival in patients undergoing surgery for adenocarcinoma of the esophagus and gastro-esophageal junction (GEJ). Methods: A cohort study of 557 patients operated for adenocarcin...
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Modified Technique for Lengthy, Curved, Zigzag Running Subcuticular with Nonabsorbable Suture
Samer Makki Mohamed Al-Hakkak
Issue:
Volume 6, Issue 1, February 2018
Pages:
8-12
Received:
27 November 2017
Accepted:
8 December 2017
Published:
5 January 2018
Abstract: The use of non-absorbable sutures rather than embedded absorbable sutures in running subcuticular technique is preferable. The reasoning is that buried knot placement and embedded suture material under the skin increases the risk of granuloma formation, ugly scarring, and infection. Removal of the suture material reduces these risks. The new modified technique adopted for easily removed of non-absorbable monofilament using in long, curved and zigzag running subcuticular suturing by put interrupted rubber or plastic tube in the special technique that helps to get easily removed sutures with wonderful, scarless, best cosmetic suture line. Technical considerations go into placing these multiple pieces of tubes along the sutures line in an easy-to-remove manner.
Abstract: The use of non-absorbable sutures rather than embedded absorbable sutures in running subcuticular technique is preferable. The reasoning is that buried knot placement and embedded suture material under the skin increases the risk of granuloma formation, ugly scarring, and infection. Removal of the suture material reduces these risks. The new modifi...
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Long-Term Survival Following Ablation of Colorectal Liver Metastases
Iben Rahbek Andersen,
Frank Viborg Mortensen,
Jakob Kirkegaard,
Finn Rasmussen,
Dennis Tønner Nielsen,
Daniel Willy Kjaer
Issue:
Volume 6, Issue 1, February 2018
Pages:
13-18
Received:
7 December 2017
Accepted:
19 December 2017
Published:
5 January 2018
Abstract: Introduction: Ablation of colorectal liver metastases (CRLM) in highly selected patients is an option with curative potential. Patient selection and the ablative technique have continued to improve over the years. This study assessed the trends in long-term survival after ablation of CRLM. Methods: We conducted a register-based cohort study of all patients with CRLM referred to ablative treatment by the multidisciplinary team for hepatic diseases at our institution between 2000 and 2014. Patient data used to calculate estimates of survival was retrieved using national registries. Patients were divided into three subgroups according to time of ablation (2000-2004; 2005-2009, and 2010-2014). Survival was defined as the time from the first ablation procedure until death, censoring or end of the follow-up period (December 31, 2015). Results: 741 CRLM ablations were performed in 444 patients. The estimated 5-year survival from first ablation procedure was for 2000-2004: 18.9% (95% CI: 10.7-28.8%); 2005-2009: 31.1% (95% CI: 24.3-38.2%); and 2010-2014: 53.3% (95% CI: 44.3-61.5%). Log rank test showed a statistically significant difference in the survival between the three subgroups (p < 0.001). Conclusion: Survival rates improved from 2000 to 2014 probably owing to multiple factors, including advances in ablation procedures, oncological therapy, and optimized patient selection.
Abstract: Introduction: Ablation of colorectal liver metastases (CRLM) in highly selected patients is an option with curative potential. Patient selection and the ablative technique have continued to improve over the years. This study assessed the trends in long-term survival after ablation of CRLM. Methods: We conducted a register-based cohort study of all ...
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Incisional Hernia Post Laparotomy-Incidence and Risk Factors
Amjad Shah,
Zia Aftab,
Syed Muhammad Ali,
Salah Gehani,
Khalid Ahmed,
Ahmed Almodaris,
Rashad Fouad,
Abdulrahman Al-Aal
Issue:
Volume 6, Issue 1, February 2018
Pages:
19-22
Received:
27 November 2017
Accepted:
8 December 2017
Published:
16 January 2018
Abstract: Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related like history of diabetes, obesity, smoking, sex and age. The other factors are related to the disease process itself like emergency surgeries, presence of peritonitis, history of radiation to the abdominal cavity or presence of surgical site infection. Another set of factors relates purely with the technique used to close the wound, choice of suture material and expertise of the surgeon. Methods. This is a retrospective chart review. Data was collected from all patients who were previously admitted at Hamad General Hospital for laparotomy and subsequently developed incisional hernia. Methods. All patients of age 18 years or above who were found to have incisional hernia after laparotomy were included in the study. Hospital medical records database were used for file reviews. Patients characteristics like age, sex, obesity, history of smoking, DM etc were recorded. Nature of surgeries like emergency or elective were documented along with other factors like suturing techniques etc. Results. The total number of study subjects was 672, out of which 47 (6.9%) developed incisional hernia. Out of these 23 were male and 24 were female. Diabetes was identified in 18 patients (38.3%) whereas the incidence of smoking, steroid use, COPD and obesity was 2 (4.3%), 0 (%), 3 (6.4%) and 7 (14.9%) respectively. Other risk factors like the nature of surgery (emergency vs electives) were addressed also. The incidence of immediate postop complications was also addressed. Three patients out of 47 (6.4%) developed surgical site infection whereas one patient (2.1%) had post -op wound dehiscence. The number of contaminated and dirty wounds during the initial surgery was 10 (21.3%) and 6 (12.8%) respectively.
Abstract: Laparotomy incisions are one of the most common procedures performed in any surgical service. However, they carry certain risks like surgical site infections, wound dehiscence and incisional hernia. There have been various risk factors associated with the incidence of incisional hernia post laparotomy. Some of these factors are patients- related li...
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Comparative Study between Mesh Fixation vs. Non-Fixation in Totally Extraperitoneal Hernioplasty for Inguinal Hernia
Osama Hasan Abd-Raboh,
Mohamed Abdallah Hablus,
Ahmed Abdelfatah Elshora,
Sherif Abdelfatah Saber
Issue:
Volume 6, Issue 1, February 2018
Pages:
23-28
Received:
13 January 2018
Accepted:
26 January 2018
Published:
19 February 2018
Abstract: Aim of the work: Randomized comparative study comparing outcome of mesh fixation versus non-fixation in TEP technique for inguinal hernia repair. Methods: In Tanta University Hospitals, over the period from February 2015 to October 2017, 58 patients with with 67 inguinal hernias (9 bilateral) undergoing TEP technique were randomized into 2 groups: Group A; mesh fixation 31 patients with 35 hernias. Group B; mesh non-fixation 27 patients with 32 hernias. Follow up was 6-17 months. Results: There was no statistical difference between 2 groups regarding operative time, postoperative complications, length of hospital stay and risk of chronic groin pain. Postoperative pain score was higher in Group A (mesh fixation). There was one case of hernia recurrence in group A (hernia and recurrence were both indirect), however, risk of hernia recurrence was not statistically significant. Conclusion: Mesh fixation and non-fixation in TEP are comparable regarding operative time, complications and hospital stay, while pain score was higher with mesh fixation. Mesh fixation does not increase the risk of chronic groin pain, while non-fixation does not increase hernia recurrence rate. Both techniques were proved safe.
Abstract: Aim of the work: Randomized comparative study comparing outcome of mesh fixation versus non-fixation in TEP technique for inguinal hernia repair. Methods: In Tanta University Hospitals, over the period from February 2015 to October 2017, 58 patients with with 67 inguinal hernias (9 bilateral) undergoing TEP technique were randomized into 2 groups: ...
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Prognostic Factors of Non-Traumatic Small Bowel Perforation Peritonitis: A Multicenter Study in North Benin
Montcho Adrien Hodonou,
Salako Alexandre Allode,
Bio Tamou-Sambo,
Djifid Morel Seto,
Mahougnon Hermann Houegnanou,
Francis Moïse Dossou
Issue:
Volume 6, Issue 1, February 2018
Pages:
29-32
Received:
24 December 2017
Accepted:
15 January 2018
Published:
19 February 2018
Abstract: Objective: Identify the factors affecting the non-traumatic intestinal perforations peritonitis outcome. Methods: This was a retrospective study over a period of 30 months (1st January 2014 – 30th June 2016), which took place in four hospitals in northern Benin, including three district hospitals and one teaching hospital. The study population consisted of patients operated for generalized acute peritonitis. The inclusion criteria were: peroperative confirmation of the non-traumatic ileal perforation and the existence of a complete medical record in relation to the variables studied. Results: We collected 121 cases of non-traumatic ileal perforation peritonitis with a total of 447 cases of generalized acute peritonitis; the non traumatic ileal perforation peritonitis frequency was 27.1%. Ninety-nine files met the inclusion criteria. The mean age was 17 ± 12 years with extremes of 2 and 60 years. The sex ratio was 2.4. The predictive factors were: age (p 0.00), consultation time (p 0.03), surgical time (p 0.02), amount of peritoneal fluid (p 0.001), perforation number (p 0.0009), surgical technique (p 0.0003) and postoperative complications such as digestive fistula (p 0.001) and postoperative peritonitis (p 0.04). Conclusions: At the end of our study, the factors of bad prognosis identified were the age, the time of consultation, the time of surgery, the quantity of peritoneal fluid. Some postoperative complications may cause death.
Abstract: Objective: Identify the factors affecting the non-traumatic intestinal perforations peritonitis outcome. Methods: This was a retrospective study over a period of 30 months (1st January 2014 – 30th June 2016), which took place in four hospitals in northern Benin, including three district hospitals and one teaching hospital. The study population cons...
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