Surgical endoscopy
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Comparative Study
Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison.
The laparoscopic approach to pancreaticoduodenectomy has been recently more frequently reported and is now being performed at multiple centers across the US. While laparoscopic pancreaticoduodenectomy (LPD) has been shown to be safe and feasible, comparing its cost in relation to open pancreaticoduodenectomy (OPD) has not been examined. The aim of this study is to examine the cost of LPD compared with OPD at a single institution over a 3-year time period. ⋯ LPD is associated with equivalent overall cost compared with OPD. While operating time and supply costs were higher for LPD, this was balanced by decreased cost of the postoperative admission.
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Comparative Study
Optimizing cost and short-term outcomes for elderly patients in laparoscopic colonic surgery.
Elderly patients often are regarded as high-risk for major abdominal surgery because of a lack of functional reserve and associated medical comorbidities. The goal of this study was to compare the cost of care and short-term outcomes of elderly and nonelderly patients undergoing laparoscopic colectomy. Our hypothesis was that elderly patients managed with laparoscopic colorectal surgery and an enhanced recovery protocol (ERP) can realize the same benefits of lower hospital length of stay (LOS) without increasing hospital costs or readmission rates. ⋯ Combining laparoscopic colectomy with an ERP is cost-effective and results in similar short-term outcomes for the elderly and nonelderly patients. Despite higher comorbidities, elderly patients realized the same benefits of shorter LOS with similar hospital costs and readmission rates.
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Comparative Study
Impact of a bladder scan protocol on discharge efficiency within a care pathway for ambulatory inguinal herniorraphy.
Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38%, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR. ⋯ After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.
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Surgical site infection (SSI) and incisional hernia (IH) are among the most common complications after colorectal surgery. While many risk factors for these complications are unavoidable, evidence suggests that use of Pfannenstiel incisions for specimen extraction during laparoscopic procedures may reduce their incidence. The objectives of this study were to identify risk factors for extraction site SSI (primary objective) and IH (secondary objective) in patients undergoing laparoscopic colorectal surgery. ⋯ Alterations in surgical technique and specimen extraction site can reduce wound-related complications after laparoscopic colorectal resections. Remaining risk factors are largely nonmodifiable from a surgeon's perspective.
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Patients with choledochocystolithiasis generally undergo endoscopic sphincterotomy (ES) followed by elective cholecystectomy. They can experience the development of recurrent biliary events while waiting for their scheduled surgery. ⋯ According to the study findings, prophylactic stent insertion during ERCP before cholecystectomy has no impact on biliary complications.