ANZ Journal of Surgery

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Wiley Online Library : ANZ Journal of Surgery
Updated: 1 day 2 hours ago

25, 50 & 75 years ago

May 4, 2017 - 08:58

Early experience with totally laparoscopic major hepatectomies: single institution experience with 31 consecutive cases

May 4, 2017 - 08:55
Background

Totally laparoscopic major hepatectomy (LMH) is a technically challenging procedure with limited studies mainly from high-volume expert centers reported. In this study, we report our initial experience with totally LMH.

Methods

A retrospective review of a prospective database of 340 consecutive patients who underwent laparoscopic liver resection at a single institution was conducted. Thirty-one consecutive patients who underwent attempted totally LMH between March 2011 to December 2016 were identified. Major hepatectomies were defined as resection of ≥3 contiguous segments which included only right/left hepatectomies, extended hepatectomies or central hepatectomies.

Results

The procedures included 11 right hepatectomies, one extended right hepatectomy, nine left hepatectomies (two including middle hepatic vein), two extended left hepatectomies, two left hepatectomies with caudate lobe and six central hepatectomies. The median tumor size was 40 (range, 12–100) mm and the median operation time was 435 (range, 245–585) min. Median blood loss was 500 (range, 100–1900) mls and 10 (32.3%) patients required blood transfusion. There were three (9.7%) open conversions of which two occurred during the first five cases. There was one (3.2%) major (>grade 2) morbidity and there were no 30-day/in-hospital mortalities or reoperations. The median postoperative stay was 5 (range, 3–14) days.

Conclusion

Our initial experience confirms the feasibility and safety of LMH. There was an increase in the number and proportion of LMH performed at our institution over time.

Impact of avoiding post-operative urinary catheters on outcomes following colorectal resection in an ERAS programme: no IDUC and ERAS programmes

May 3, 2017 - 01:48
Background

The presence of an indwelling urinary catheter (IDUC) is routine following colorectal resections. In Enhanced Recovery After Surgery programmes, excessive intravenous fluids (IVFs) are avoided. This study sought to determine whether the routine absence of an IDUC following colorectal surgery improved post-operative outcomes and minimized fluid prescription.

Methods

A retrospective comparative cohort study was performed on patients undergoing colorectal resection at a tertiary referral teaching hospital, over a 7-year period. A policy of no routine IDUC was introduced over the last 3 years. Patients were divided into cohorts based on the presence or absence of an IDUC on leaving the operating theatre. The outcomes assessed were IVF prescription, length of stay, mortality and morbidity.

Results

Of the 213 resections over the time period, 131 met the inclusion criteria (87 IDUC and 44 no IDUC). There was no difference between groups with respect to baseline demographics. Fluid administration was less in the group without routine IDUC (total fluid 6.16 L versus 10.89 L; P < 0.0001, fluid in the first 24 h 3.82 L versus 5.3 L; P < 0.0001 and fluid in the first 48 h 5.15 L versus 7.23 L; P < 0.0001). Length of stay was less in the ‘no IDUC’ group (5.9 days versus 10.1 days; P = 0.0009). There was no difference in morbidity and mortality.

Conclusion

A policy of no IDUC following colectomy was associated with a reduction in IVF administration and length of stay. A randomized controlled trial is recommended in order to more accurately determine the degree of causal relationship.