Surgical endoscopy
-
Clinical Trial
Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes.
Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay. ⋯ Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.
-
Due to the steady increase in patients on chronic dialysis, more of these patients are undergoing elective operations. The literature on safety and postoperative outcomes in dialysis-dependent patients following elective bariatric surgery is scant. We compared the 30-day major morbidity and mortality rates in dialysis-dependent (DD) and non-dependent (ND) patients after primary bariatric surgery. ⋯ Primary bariatric surgery is safe in patients dependent on dialysis with an acceptable 30-day postoperative morbidity and mortality. Even though dependence on dialysis does not independently increase the risk of 30-day adverse outcomes following primary bariatric surgery, the comorbid conditions in this patient population render them at risk. The higher prevalence of major morbidities in this group is mainly due to the impact from older age, male sex, higher BMI, cardiac comorbidities, and hypertension.
-
Widespread adoption of minimally invasive surgery (MIS) techniques in pediatric surgery has progressed slowly, and the shift in practice patterns has been variable among surgeons. We hypothesized that a pediatric surgeon committed to MIS could effectively change surgical practice by creating an emphasis on MIS. ⋯ The presence of a dedicated minimally invasive pediatric surgeon led to a significant change in surgical practice with an overall trend of increasing MIS several years in advance of a hospital that did not have a dedicated MIS surgeon. This has implications for resident training in academic medical centers and potential patient care outcomes.
-
Bariatric surgery has been established as the most effective long-term treatment for morbid obesity. ⋯ Bariatric surgery is feasible in the SSO patients with comparable EWL outcomes and postoperative complications to historical non-SSO patients.
-
Tumors in the stomach have traditionally been treated with either subtotal gastrectomy or total gastrectomy, depending on the location. However, many of these lesions are benign spindle cell tumors or adenomas and could be resected with margins. Here, we explore multiple minimally invasive methods for the resection of these tumors. We highlight a wedge resection, a circumferential resection with transverse closure, a transgastric resection, and an endoscopic/laparoscopic submucosal resection. The wedge resection was performed in a 71-year-old man found to have a mass in the stomach on screening upper endoscopy. The biopsy was not definitive, but on CT scan there was a 4.5-cm submucosal mass consistent with a gastrointestinal stromal tumor. The circumferential resection was performed for an 83-year-old woman who had abdominal discomfort which led to an upper endoscopy. She was found to have a mass in the lesser curve of her stomach. Biopsy revealed this to be a gastrointestinal stromal tumor. Ultimately, it was removed when serial CT scans showed that it was growing. The transgastric approach was used for a 75-year-old man who had upper endoscopy for reflux symptoms and was found to have a mass in the stomach. Biopsy showed that it was a gastrointestinal stromal tumor. Due to patient preference, it was initially observed but was eventually removed when it was found to be growing on serial CT scans. The endoscopic/laparoscopic approach was for a 65-year-old man who had an upper endoscopy performed for work-up of melena and was found to have a 5-cm mass at the gastroesophageal junction. The biopsy showed this to be an adenoma, and he went on to have it removed. ⋯ Minimally invasive techniques should be considered more frequently for the management of benign gastric tumors. The four methods illustrated here can be used safely and result in faster recovery as well as shorter hospital stays compared to traditional approaches.