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At least 127 records · Page 7Linked to original sources

PubMed1991

Combined study to assess the role of calcium alginate swabs and ligation of the inferior tonsillar pole in the control of intra-operative blood loss during tonsillectomy.

Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing haemostasis. Calcium alginate reduces experimental wound blood loss. This study assessed the efficacy of alginate swabs during tonsillectomy and inferior tonsillar pole ligation in the control of blood loss during tonsillectomy. Ninety-nine tonsillectomy patients were randomized to gauze or alginate swab use. A haemoglobinometer measured blood losses collected by suction during dissection and by swab until haemostasis was secured. Operative time, complications and healing were also assessed. Mean total blood losses and operative times were similar for the two groups. Swab blood loss was significantly lower for surgeons who ligated the lower tonsillar pole, compared with surgeons who used a snare. This finding was independent of swab type. Independent assessment showed no difference in the healing rate. Alginate swabs offer no advantage over gauze in terms of blood loss, operative time or complications of tonsillectomy. The results show that routine lower pole ligation significantly reduces post-dissection blood loss. We suggest that this technique should be more widely adopted.

Adolescent↗

PubMed1985

Sutureless intraluminal graft for repair of abdominal aortic aneurysm.

A series of seven patients undergoing elective repair of abdominal aortic aneurysms using sutureless intraluminal aortic prostheses for infrarenal tube grafts was reviewed. Follow-up was five to seven months. There was no morbidity related to the graft and one late mortality. In the uncomplicated cases, the average total operative time was two hours 14 minutes with no bank blood transfusions. The overall average operative time was two hours 41 minutes with an average operative transfusion of 0.28 units and total transfusions of 1.70 units of bank blood per case. Based on this experience and the observation that operative time and blood loss are major determinants of mortality with emergency abdominal aortic aneurysm repairs, we believe that use of sutureless intraluminal prostheses in suitable cases of leaking or ruptured abdominal aortic aneurysms has the potential to markedly improve survival.

Aorta, Abdominal↗

PubMed1994

Laparoscopic varicocelectomy: invasiveness and effectiveness compared with conventional open retroperitoneal high ligation.

The invasiveness of laparoscopic varicocelectomy and open retroperitoneal high ligation of the internal spermatic veins were compared and the surgical effects on fertility of these two procedures determined. 48 of 97 men diagnosed with varicocele testis underwent laparoscopic varicocelectomy, while the remaining 49 underwent open retroperitoneal high ligation of the internal spermatic vessels. Operating time, number of post-operative days to walking, length of hospital stay and analgesic use were measured as peri-operative indicators of invasiveness. In addition, seminal parameters were determined in order to evaluate the effects of these procedures on fertility. The operating time required for laparoscopic surgery was significantly longer than that for open surgery (96.6 vs 78.1 min., p = 0.0078). The patients in the laparoscopic surgery group began walking earlier post-operatively than did those who underwent open high ligation (0.97 vs 1.42 days, p = 0.00037). Length of hospital stay for the laparoscopic patients was shorter than for the open surgery group (7.05 vs 9.55 days, p = 0.00001). There were no statistical differences between the groups in terms of semen quality or improvement in the post-operative rate of pregnancy of partners. These findings indicate that laparoscopic varicocelectomy is associated with a shorter period of convalescence than open high ligation of the internal spermatic vessels.

Adolescent↗

PubMed1993

Transanal endoscopic microsurgery using a newly designed multifunctional bipolar cutting and monopolar coagulating instrument.

In order to save time for changing instruments and minimize thermal damage in underlying tissue caused by monopolar high frequency in transanal endoscopic microsurgery (TEM), we have developed a new electrosurgical instrument, in which four functions are integrated: bipolar cutting, monopolar coagulation, suction and irrigation. The new device and the conventional monopolar knife were tested during both in vitro and in vivo experiments to compare the thermal alterations and effects on operating time. In vitro experiments demonstrated that the extent of thermal alterations created by bipolar cutting was less than in the case of monopolar cutting in the fresh porcine liver and bovine rectum. The mean severity scores for carbonization, coagulation and vacuolization in the resected mucosae obtained during in vivo animal operations by the bipolar procedure were 2.09, 2.27 and 1.36, respectively, whereas those obtained using the monopolar technique were 2.64, 2.82 and 2.36, respectively. The new device required an average operation time of 673.5 seconds, whereas the conventional setup required 701.9 seconds to resect the same diameter of rectal mucosa. Reduced operation time with the new device was mainly attributable to the reduced time needed for changing the instruments for hemostasis. The decreased thermal damage to the underlying bowel wall produced by the bipolar procedure should reduce the incidence of such operative complications in TEM (Transanal Endoscopic Microsurgery, developed in 1983 by Buess, Theis and Hutterer) as perforation, dehiscence in the suture line or post-polypectomy coagulation syndrome. By quickly switching between the multiple functions of this new device a clear operative field can always be achieved, thus decreasing operation time and bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Anal Canal↗

PubMed1992

The impact of selective use of dipyridamole-thallium scans and surgical factors on the current morbidity of aortic surgery.

Preoperative cardiac testing in patients undergoing vascular surgery remains controversial. We have advocated selective use of dipyridamole-thallium scans based on clinical markers of coronary artery disease before aortic surgery. The present study assessed both the efficacy of this policy and the role of surgical factors in the current morbidity of aortic reconstruction. Two hundred two elective aortic reconstructions (151 abdominal aortic aneurysms, 51 aortoiliac occlusive disease) performed in the period from January 1989 to June 1990 were reviewed. Preoperative dipyridamole-thallium scanning was performed in 29% of all patients, prompting coronary angiograms in 11% and coronary artery bypass grafting/percutaneous transluminal coronary angioplasty in 9% of patients before aortic reconstruction. The overall operative mortality rate was 2%, with one cardiac-related death. Major cardiac (nonfatal myocardial infarction, unstable angina) and pulmonary complications occurred in an additional 4% and 6%, respectively, of patients. Coronary artery disease clinical markers and surgical factors were analyzed with stepwise logistic regression for the prediction of operative mortality rates and major cardiopulmonary complications. Variables retaining significance in predicting postoperative death or cardiopulmonary complications included prolonged (more than 5-hour) operative time (p less than 0.004), operation for aortoiliac occlusive disease (p less than 0.010), and a history of ventricular ectopy (p less than 0.002). Prolonged operative time (p less than 0.006) and the detection of intraoperative myocardial ischemia (p less than 0.030) were predictive of major cardiac complications after univariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

Laparoscopic Pomeroy tubal ligation as a teaching model for residents.

We reviewed our preliminary experience with laparoscopically directed bilateral midtubal resection for tubal ligation (endoscopic Pomeroy) as a potential teaching tool for the acquisition of endoscopic skills during residency training. Thirty-five laparoscopic Pomeroy and 206 banding procedures were reviewed. Age, parity and weight were similar in the two groups. The operative time for banding was reduced slightly after experience with > 10 procedures. In contrast, the operative time for laparoscopic Pomeroy procedures decreased dramatically after individual experience with only a few (< or = 5) procedures. The mean operative time for the Pomeroy group approached that of the more traditional banding technique at five procedures. Our data indicate that laparoscopic Pomeroy sterilization can be an effective teaching tool for operative laparoscopy, allowing residents to repeatedly perform an easy and safe procedure that incorporates basic techniques. Advanced operative endoscopic procedures could then be taught more efficiently after the acquisition of basic skills.

Adult↗

PubMed1989

Totally stapled abdominal restorative proctocolectomy.

A technique of totally stapled abdominal restorative proctocolectomy is reported in 20 consecutive patients using a 20 x 20 cm J pouch and a stapled ileoanal anastomosis. The stapled ileoanal anastomosis had to be abandoned in three patients because of attempted mucosectomy in one and megarectum in two. One patient receiving steroids had a covering ileostomy. The remaining 16 patients had a totally stapled procedure without a covering ileostomy. Three patients developed serious postoperative morbidity but they were the only patients receiving steroids at the time of the operation. Of the remaining 13 patients none developed serious complications, the median hospital stay was 14 days and the median operating time was 150 min. The operation may be a technical advance particularly in allowing pouch construction without ileostomy in fit patients who are not receiving steroids at the time of operation.

Adolescent↗

PubMed2026

Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial.

OBJECTIVE: To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure. DESIGN: Single-blind, multicentre randomised controlled trial. SETTING: Two Dutch non-academic teaching hospitals. POPULATION: Women aged ≥ 18 years undergoing hysterectomy for benign indications. METHODS: Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis. RESULTS: A total of 113 patients were included in the analyses (n = 42 VH, and n = 71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p = 0.04). VANH was associated with a significantly shorter operative time (median 55 min versus 65 min; p = 0.005), less blood loss (median 50 mL vs. 150 mL; p < 0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p = 0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p < 0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p = 0.34), readmission (VH 4.8% vs. VANH 8.5%; p = 0.47), analgesic use, recovery, and quality of life were not statistically significant. CONCLUSIONS: VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.

Humans↗

PubMed1994

Volume determinations of the whole prostate and of adenomas by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: correlation of resected weight, blood loss and duration of operation.

OBJECTIVE: To study whether transrectal ultrasound (TRUS) volume determinations of the whole prostate and of the adenomas alone correlate to resected weight, operation time and blood loss in patients operated upon with transurethral resection of the prostate because of presumed benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: The whole prostate and the transition zone, which corresponds to the adenomas, were measured separately in 159 patients with presumed BPH, pre-operatively and 4 months post-operatively. RESULTS: The transition zone volume correlated well with the resected weight (r = 0.91; P < 0.0001), the blood loss (r = 0.67; P < 0.0001) and the operation time (r = 0.67; P < 0.0001). Four months post-operatively a reduction of the total prostate volume was recorded which corresponded well with the resected weight (r = 0.91; P < 0.0001). CONCLUSION: TRUS with high resolution 7 MHz probes successfully estimated the size of the whole prostate and that of the adenomas alone. The transition zone volume predicted the expected resection weight of adenomas and to some extent the duration of the operation and the blood loss. These calculations may be used for more accurate pre-operative planning. Together with its superior detection rate for prostate cancer, TRUS seems to be a powerful tool in the pre-operative morphological assessment of patients with prostatism.

Aged↗

PubMed1985

Pseudarthrosis after spinal fusion for scoliosis. A comparison of autogeneic and allogeneic bone grafts.

This study was undertaken to compare the incidence of pseudarthrosis in fusions supplemented with autogeneic and frozen allogeneic grafts. The records of 208 patients with adolescent idiopathic scoliosis who were treated by posterior fusion and Harrington instrumentation were studied. The fusion was supplemented by an autogeneic iliac bone graft in 114 patients and by an allogeneic bank bone graft in 94 patients. The fusion mass was explored in all patients with suspected pseudarthrosis; therefore, all pseudarthroses reported in this series were proved by surgical exploration. Pseudarthrosis developed in five patients (4.4%) receiving an autogeneic graft and in five patients (5.3%) receiving an allogeneic graft. The incidence of pseudarthrosis was not significantly different at the 95% level of certainty. Average blood loss and operative time were determined for all patients. The decreases in average blood loss and operative time in those patients receiving allogeneic grafts were significant (p less than .01). Thus, based on the incidence of pseudarthrosis, allogeneic frozen bank-stored bone is an attractive alternative to autogeneic iliac bone for fusion supplementation in the treatment of scoliosis. Total operative time and blood loss can be decreased, and possible complications associated with a donor site can be avoided.

Adolescent↗

PubMed1995

Fibrin sealant reduces suture line bleeding during carotid endarterectomy: a randomised trial.

OBJECTIVES: To determine whether topical fibrin sealant reduced suture line bleeding during carotid endarterectomy with polytetrafluoroethylene (PTFE) patch closure. DESIGN: Prospective randomised non-blinded control trial. SETTING: Regional vascular surgery unit. MATERIALS: Seventeen patients undergoing carotid endarterectomy were randomised either to receive fibrin sealant as a topical haemostatic agent at the arteriotomy suture line or to act as control. OUTCOME MEASURES: Time taken to achieve haemostasis at the suture line. Intraoperative blood loss. Total operative time. RESULTS: The median time to achieve haemostasis was 5.5 min (range 4-31 min) in the treatment group and 19 min (range 10-47 min) in the control group. This difference was statistically significant p < 0.005 by Mann-Whitney test. There was no statistical difference in total operative time. Operative blood loss was lower in the treatment group (median 420ml, range 300-500ml) than in the control group (median 550ml, range 350-1200ml) but this difference was not statistically significant. One patient in the control group suffered a perioperative thrombo-embolic event. CONCLUSION: Fibrin sealant is an effective topical haemostatic agent for arteriotomy suture lines involving PTFE material.

Aged↗

PubMed1976

[Relationship between the proliferation waves of the hepatocytes after hepatectomy and the waves of diurnal rhythm of mitotic activity. 1. Dependence of the form of the mitotic wave and the time of attaining its maximal degree on the time of operation].

The diurnal rhythm of mitotic activity (MA) of intact animal hepatocytes and the proliferative wave of hepatocytes after partial hepatactomy at time t0 are thought to appear as a result of formation of an initial proliferative wave, Pk-wave, within the G0-phase at constant moments of the day--time tk+1=tk+TMA(TMA=24hrs/K, k=1, or 2, . . ., or K) under the influence of the regulating system of the organism. Cells of the Pk-wave pass during a short time deltat (deltat less than TMA) from the G0-phase into the transformation phase, and then into the G1-phase. The 1st stimulated proliferative wave is formed at time tk, if tk--TMA less than t0 less than or equal to tk; its intensity depends most likely on the intensity of the corresponding Pk-wave of the intact liver. It was noted that time t0 of partial hepatectomy was necessary to coordinate with tk, but not with the time of the maximal mitotic activity, and that it was necessary to hepatectomize all animals within the interval from time tk--TMA to time tk. The model was shown to compare well with data by Post et al. (1963), Barbason (1970), and Van Cantfort and Barbason (1972) for hepatocytes of Wistar rats with TMA=8hrs, and tk (k=1,2,3) within intervals (2 a.m.; 4 a.m), (10 p.m.; noon), and (6 p.m. 8 p.m.). The maximal rate of liver generation was observed for all the hepactomized animals with the time of operation being between 8 p. m. and 2 a.m.

Animals↗

PubMed1995

Criteria for safe hepatic resection.

BACKGROUND: To lower morbidity after hepatic resection, the authors examined the influence of predictor variables including: age, sex, preoperative risk factors, serum total bilirubin level, plasma retention rate of indocyanine green at 15 minutes, underlying liver disease, operative blood loss, operation time, amount of whole blood transfused, vascular occlusion time, surgical procedure employed, and extent of hepatic resection. PATIENTS AND METHODS: Between January 1990 and December 1992, 172 patients underwent hepatic resection based on our own criteria for hepatectomy, including the presence or absence of ascites, serum total bilirubin level, and the plasma retention rate of indocyanine green at 15 minutes in patients with chronic liver disease. The morbidity rate was 37.2%, and the hospital and operative mortality rates were 2.3% and 0.6%. RESULTS: The multiple logistic model revealed that the risk of morbidity was increased by longer operation time, major hepatic resection, and preoperative cardiovascular disease. CONCLUSIONS: Shortening the operation time without increasing operative blood loss and further modalities for making major hepatectomy safer are future problems to be addressed.

Adult↗

PubMed1982

Length of operation and morbidity: is there a relationships?

In summary, it is clear that duration of surgery is positively correlated with postoperative morbidity in both major and relatively minor procedures. It should be kept in mind that the reason for this in many cases may be that the preoperative condition of the patient or the nature of the surgical procedure can affect both operative time and postoperative outcome. However, there can be little doubt of the independent influence of operative time on the incidence of wound infection and sepsis. It is also highly probably that prolonged anesthesia tends to make postoperative atelectasis and other pulmonary complications more likely to occur, especially if tidal volumes are inadequate. It can be said, too, that the anesthetist will be more likely to see arrhythmias the longer the surgeon operates. The association of myocardial infarction, renal failure, thromboembolic disease, and delirium with prolonged operation time is also a possibility.

Anesthesia↗

PubMed1988

[Diagnosis and timing of operation for strangulation ileus--especially concerning the usefulness of ultrasonography].

This is a clinical report on the usefulness of ultrasonography in the diagnosis of strangulation ileus and the timing of operation for this entity. Fifty-eight cases of strangulation ileus were investigated retrospectively and twenty-five cases had undergone ultrasonography. Ultrasonography delineated the strangulated intestinal tract as an akinetic distended intestinal tract and the intestinal tract on the oral side of the strangulated part as a movable distended tract with peristalsis and to-and-fro movement of the intestinal content. Retention of ascites was seen in many cases. Utilization of ultrasonography improved the rate of accurate preoperative diagnosis of strangulation ileus to 92%, resulting in timely surgery. Consequently, the number of cases requiring enterectomy because of intestinal necrosis sharply decreased. Shock, peritoneal irritation sign, leukocytosis, roentgenographic findings were inferior to ultrasonography in the preoperative diagnosis for the prediction of intestinal necrosis in strangulation ileus.

Humans↗

PubMed2026

Surgical outcomes and complications of fixation strategies for distal tibial fractures: a systematic review and network meta-analysis.

BACKGROUND: Multiple fixation options exist for distal tibial fractures, but the optimal approach remains controversial. Common techniques includeopen reduction and internal fixation(ORIF), minimally invasive plate osteosynthesis (MIPO), external fixation combined with limited open reduction and internal fixation (EF + LORIF), intramedullary nailing (IMN), and retrograde tibial nailing (RTN). METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched through March 19, 2026. Network meta-analysis (R v4.5.1) assessed operation time, fracture healing time, malunion, delayed union/nonunion, and infection, reporting MDs or RRs with 95% CIs. RESULTS: Eleven randomized controlled trials and 18 cohort studies (2145 patients) were included. MIPO was associated with a longer operative time and a longer time to union than IMN-IP (MD = 8.23, 95% CI 0.44-16.01; and MD = 1.02, 95% CI 0.10-1.93, respectively). For malunion, ORIF had a lower risk than MIPO (RR = 0.30, 95% CI 0.11-0.82), whereas MIPO had a higher risk than EF + LORIF (RR = 3.26, 95% CI 1.08-9.80) and IMN-SP (RR = 4.03, 95% CI 1.30-12.48). ORIF, EF + LORIF, and IMN-SP also showed lower malunion risk than IMN-IP. No significant differences were observed for delayed union and nonunion. Infection risk was generally higher with ORIF and MIPO than with several comparators, particularly EF + LORIF and intramedullary nailing-based strategies. CONCLUSIONS: No single strategy was consistently superior. Operation time and impaired union ( delayed union and nonunion) did not differ significantly among techniques. MIPO may be associated with longer time to union than IMN-IP and higher malunion risk than EF + LORIF and IMN-SP. Infection risk appeared higher with ORIF and MIPO in network estimates, although several comparisons remained uncertain. Findings should be interpreted in light of imprecision and study-level heterogeneity. PROTOCOL REGISTRATION: INPLASY2025120055.

Humans↗

PubMed1990

[Gluco, lipometabolic and trace elements alteration in bile with acute purulent cholangitis].

Analysis was made of the gluco, lipometabolic materials and trace elements in bile from patients. The specimens were collected in 11 cases with acute purulent cholangitis and 13 cases of selective biliary surgery at both inter-operational time, at which the bile were got by needling from the common bile duct, and post-operational time, at which the bile was obtained from T tube drainage bile before the extraction of the T tube or discharge from hospital. It was found that lactic acid and glucose markedly decreased and LDH activity increased in the cholangitis group at inter-operational time. Lifted hepatic glyconeogenesis and gluco-consumption and hepatic cellular damage were indicated. At the same time, most of the lipo-materials and lipase activity increased, as compared with the selective group, which showed that lipolysis was encouraged and that lipo-materials had flowed into the bile because of hepatic cellular damage. At the time of acute cholangitis, the Zn and Fe in bile markedly increased but the Cr in bile decreased, and the mechanism was not clear.

Acute Disease↗

PubMed1989

Effects of preoperative embolization on glomus jugulare tumors.

The charts of 35 patients were reviewed retrospectively to determine the effects of embolization on glomus jugulare tumors. Eighteen patients underwent embolization; 17 did not. All tumors were removed with a type A infratemporal fossa approach. The charts were evaluated for operative blood loss, operative time, length of hospitalization, new postoperative cranial nerve deficits and recurrence of tumor. Embolized patients had significantly less operative blood loss and operative time. Embolization did not affect length of hospitalization or reduce the incidence of new postoperative cranial nerve deficits. The surgeon's experience also plays a central role in reducing operative blood loss and operative time. The potential risks of embolization must be considered in the treatment regimen of glomus jugulare tumors.

Adult↗