Entries Tagged as 'Am J Surg'
Do the risks of emergent colectomy justify nonoperative management strategies for recurrent diverticulitis?
Am J Surg. 2009 Feb;197(2):227-31
Authors: Novitsky YW, Sechrist C, Payton BL, Kercher KW, Heniford BT
BACKGROUND: The nonoperative approach to recurrent and even multiple recurrent diverticulitis has recently been advocated. This approach, however, may result in more frequent acute attacks requiring emergent colectomy. Our aim was to compare the colectomy outcomes for diverticulitis in the elective and acute settings. METHODS: All patients with diverticulitis undergoing elective (EL) and emergent (EM) colectomy selected from the 2001 to 2002 Nationwide Inpatient Sample Database were analyzed and compared. RESULTS: Five thousand ninety-seven (27.1% emergent) colectomy cases were analyzed. EL patients had a significantly reduced length of stay (7.5 vs 13.3 days) and total hospital charges ($25,420 vs $51,170). Postsurgical morbidity and mortality were significantly higher in the EM group (29.0% vs 14.9% and 7.4% vs .8%, respectively). Colostomy was needed in 5.7% of EL and in 48.9% of EM patients (P = .001). CONCLUSIONS: Emergent colectomy in the setting of diverticulitis is associated with significantly higher morbidity, longer hospitalization, greater hospital charges, and a 9-fold increase in mortality. Prophylactic resection in the setting of recurrent diverticulitis should continue to be an acceptable and possibly more “conservative” approach.
PMID: 18639223 [PubMed - indexed for MEDLINE]
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Gallbladder cancer.
Am J Surg. 2008 Aug;196(2):252-64
Authors: Gourgiotis S, Kocher HM, Solaini L, Yarollahi A, Tsiambas E, Salemis NS
BACKGROUND: Gallbladder cancer (GC) is a relatively rare but highly lethal neoplasm. We review the epidemiology, etiology, pathology, symptoms, diagnosis, staging, treatment, and prognosis of GC. METHOD: A Pubmed database search between 1971 and February 2007 was performed. All abstracts were reviewed and articles with GC obtained; further references were extracted by hand-searching the bibliography. The database search was done in the English language. RESULTS: The accurate etiology of GC remains unclear, while the symptoms associated with primary GC are not specific. Treatment with radical cholecystectomy is curative but possible in only 10% to 30% of patients. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated, where feasible, for all disease except T1a. Patients with advanced disease should receive palliative treatment. Laparoscopic cholecystectomy is contraindicated in the presence of GC. CONCLUSION: Prognosis generally is extremely poor. Improvements in the outcome of surgical resection have caused this approach to be re-evaluated, while the role of chemotherapy and radiotherapy remains controversial.
PMID: 18466866 [PubMed - indexed for MEDLINE]
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Sublingual hyoscyamine spray as premedication for colonoscopy: a randomized double-blinded placebo-controlled trial.
Am J Surg. 2008 Jul;196(1):51-5
Authors: Chaptini LA, Janec EM, Seltzer G, Peikin S, Elfant AB
BACKGROUND: Colonic motility and spasm during colonoscopy may affect duration and quality of the examination as well as patient comfort during and after the procedure. Previous studies assessing the utility of antispasmodic agents in colonoscopy demonstrated conflicting results. The aim of this study was to determine the effect of sublingual hyoscyamine spray (IB-Stat, Inkine Pharmaceutical) on the performance of colonoscopy. METHODS: One hundred patients undergoing elective colonoscopy were randomized in a double-blind study to receive .25 mg sublingual hyoscyamine spray (n = 50: 25 men and 25 women, mean age 60) or placebo spray (n = 50: 23 men and 27 women, mean age 56) 15 to 30 minutes before the procedure. Parameters measured included time required to reach the cecum, total procedure time, endoscopist perception of colonic motility and difficulty of the procedure, and patient assessment of discomfort after the procedure. The latter parameters were measured using a 100-mm visual analog scale. A single endoscopist performed all of the procedures. RESULTS: After adjustment for age, procedural difficulty scores and colonic motility scores were significantly lower in the hyoscyamine group compared with placebo (differences of 5.589 mm [P = .047] and 5.685 mm [P = .040], respectively). Mean time to cecal intubation and percentage of patients with discomfort were slightly lower in the hyoscyamine group (5.68 minutes/48%) compared with placebo (5.92 minutes/57.1%), although the differences were not statistically significant (P = .57 and P = .36, respectively). CONCLUSIONS: Procedural difficulty and colonic motility scores were significantly lower in subjects who received sublingual hyoscyamine before colonoscopy.
PMID: 18436182 [PubMed - indexed for MEDLINE]
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The timing of surgery for cholecystitis: a review of 202 consecutive patients at a large municipal hospital.
Am J Surg. 2008 Apr;195(4):467-70
Authors: Lee AY, Carter JJ, Hochberg MS, Stone AM, Cohen SL, Pachter HL
BACKGROUND: Traditionally, cholecystectomy for cholecystitis is performed within 3 days of the onset of symptoms or after 5 weeks, allowing for resolution of the inflammatory response. This study reviewed the outcomes of cholecystectomy performed for patients with gallstone disease in the acute (n = 45), intermediate (n = 55), and delayed (n = 102) periods after the onset of symptoms. METHODS: The medical records of 202 patients who underwent laparoscopic cholecystectomy at a large municipal hospital were reviewed retrospectively. The primary outcomes studied were length of hospital stay, conversion to open cholecystectomy, and complications. RESULTS: There was no significant difference in the conversion rate (acute [18%] vs intermediate [20%] vs delayed [11%]) or complication rate (acute [16%] vs intermediate [9%] vs delayed [7%]) among the 3 groups. The delayed group had a significantly shorter length of hospital stay than the intermediate or acute group (3.1 +/- 3.8 vs 4.3 +/- 3.8 vs 1.7 +/- 2.1, respectively, P < .001). CONCLUSIONS: Patients who present with acute symptoms of cholecystitis should undergo surgery during the same admission, regardless of the duration of symptoms.
PMID: 18361924 [PubMed - indexed for MEDLINE]
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