Surgical endoscopy
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Routine histopathological examination of gallbladder specimens is mainly performed to identify unexpected gallbladder carcinoma (GBC). This systematic review assesses the prevalence and characteristics of GBC in cholecystectomy specimens. ⋯ The histopathological finding of GBC after cholecystectomy appears to be a rare event. The prevalence of unexpected GBC was higher in Asian studies than in Western studies. The pre- and intraoperative sensitivity for this carcinoma is low. Moreover, the diagnosis of GBC at the time of histopathology is usually inconsequential. The results of this systematic review do not support routine histopathology of cholecystectomy specimens in clinical practice.
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Comparative Study
Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison.
The laparoscopic approach to pancreaticoduodenectomy has been recently more frequently reported and is now being performed at multiple centers across the US. While laparoscopic pancreaticoduodenectomy (LPD) has been shown to be safe and feasible, comparing its cost in relation to open pancreaticoduodenectomy (OPD) has not been examined. The aim of this study is to examine the cost of LPD compared with OPD at a single institution over a 3-year time period. ⋯ LPD is associated with equivalent overall cost compared with OPD. While operating time and supply costs were higher for LPD, this was balanced by decreased cost of the postoperative admission.
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Comparative Study
Revisional bariatric surgery: perioperative morbidity is determined by type of procedure.
Revisional bariatric procedures are on the rise. The higher complexity of these procedures has been reported to lead to increased risk of complications. The objective of our study was to compare the perioperative risk profile of revisional bariatric surgery with primary bariatric surgery in our experience. ⋯ In experienced hands, many revisional bariatric procedures can be accomplished safely, with excellent perioperative outcomes that are similar to primary procedures. As the complexity of the revisional procedure and number of prior surgeries increases, however, so does the perioperative morbidity, with fundoplication revisions to gastric bypass representing the highest risk group.
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Comparative Study
Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery.
Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates. ⋯ Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.
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Surgical site infection (SSI) and incisional hernia (IH) are among the most common complications after colorectal surgery. While many risk factors for these complications are unavoidable, evidence suggests that use of Pfannenstiel incisions for specimen extraction during laparoscopic procedures may reduce their incidence. The objectives of this study were to identify risk factors for extraction site SSI (primary objective) and IH (secondary objective) in patients undergoing laparoscopic colorectal surgery. ⋯ Alterations in surgical technique and specimen extraction site can reduce wound-related complications after laparoscopic colorectal resections. Remaining risk factors are largely nonmodifiable from a surgeon's perspective.