Int Surg
-
Randomized Controlled Trial Comparative Study Clinical Trial
Cholecystectomy: comparison of minilaparotomy and laparoscopy.
Laparoscopic cholecystectomy (LC) has become the most popular method of removing the gallbladder. Because it is an expensive operation requiring special training for the team, LC has been challenged by other methods of minimal-access surgery, e.g. by minilaparotomy (MC). This study was planned to be a single-surgeon prospective random study to compare minilaparotomy cholecystectomy (MC) and laparoscopic cholecystectomy (LC), but was never done over the pilot phase. ⋯ In the MC group three patients (37%) had complications versus no complications in the LC group (p = 0.028). Postoperative hospital stay was longer in the MC group (median three days) than in the LC group (median one day), even when the patients with complications were excluded. Due to these discouraging experiences the extended random study was never done, and MC was abandoned.
-
Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a 5 year period were retrospectively analyzed in order to assess those factors related to early deaths. Mean age was 32 and 45 were male. GSW was the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and blunt trauma (12.2%). ⋯ Mortality rate was 100% in supra diaphragmatic injuries, 71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries. There was a significant difference when comparing mortality rate in stable against shock or unstable patients on admission (p < 0.001), as well as in those with diaphragmatic IVC injuries compared with all other injury sites together (p < 0.05). Hemodynamic instability on admission was the most important cause of early deaths, and all patients with concomitant abdominal vascular injuries also died.
-
To evaluate the efficacy of a single application of epidural anesthesia without endotracheal intubation for elderly patients over 80 years of age, the data on 108 patients who underwent abdominal surgery were analyzed for the occurrence of postoperative complications. These patients were classified into two groups according to the type of anesthesia performed: 66 received epidural anesthesia alone (Group I) and 42, general anesthesia under endotracheal intubation (Group II). ⋯ The occurrence of pulmonary complications in Group I was not related to the operating time, while pulmonary complications frequently occurred in patients who underwent lengthy operations in Group II. These findings suggest that a single application of epidural anesthesia would improve the overall safety in performing abdominal surgery in elderly patients over 80 years of age.
-
A retrospective review was performed of 98 patients admitted to a Level I Trauma Center between July 1989 and December 1990 with a diagnosis of blunt chest trauma. Of these patients, 49% suffered either immediate or delayed complications. Immediate complications included hemothorax or pleural effusion in 21.4%, pneumothorax in 36.7%, and ruptured diaphragm in 2%. ⋯ Similarly, 51.8% of patients with ISS < 16 had complications. Statistically, neither TS nor ISS could be used to predict complications, regardless of the reference value chosen for TS or ISS. Therefore, it is imperative that all patients with blunt trauma be considered at risk for secondary complications, even those with "favorable" TS or ISS.