- Email: [email protected]
W1497 General Surgery in Nonagenarians: A Single Institution's Ten Year Experience
for Gallstone Surgery and ERCP (GallRiks) was founded in May 2005, with the aim of registering indications, complications, results and quality of life outcome of gallstone surgery. By the end of 2007, the register covered 56 hospitals. Altogether 8804 cholecystectomies and 5042 ERCP have been registered. As a pilot study SF-36 has been filled in prior to surgery and 6-9 months postoperatively at some of the units. Four of these hospitals were chosen for this study. Expected SF-36 scores were determined from the age- and gendermatched population. Linear Multivariate regression analysis was performed to assess which factors had the greatest impact on the responsiveness.
Results: Out of 206 operated patients, 148 responded to the SF-36 questionnaire prior to and 6-9 months post surgery, yielding a response rate of 72% (= 148/206). Standardized response means ranged from 0.20 to 0.82 for the SF-36 sub scores. The highest responsiveness was seen for bodily pain. Prior to surgery, all sub scores were significantly lower than in the general population (all p<0.05). Six months after surgery, all sub scores were equal to or higher than the expected except for general health (p<0.05). Low age, laparoscopic surgery and cholecystitis, pancreatitis or jaundice as indication for surgery were found to be associated with significantly higher improvement of physical component summary in multivariate linear regression analysis (all p<0.05).
Conclusion: SF-36 is a useful instrument for measuring the impact of gallstone surgery on quality of life. Good quality requires careful consideration of indication for surgery as well as use of adequate technique.
W1494 Surgical Gastrostomy for Pancreatobiliary and Duodenal Access Following Roux En Y Gastric Bypass Jessica M. Gutierrez, Howard Lederer, Jon C. Krook, Oliver W. Cass, Timothy P. Kinney, Martin L. Freeman, Eric H. Jensen
W1497
Introduction: To date there have been no published studies exploring outcomes of nonagenarians undergoing general surgical operations. Such data is particularly important in the setting of continued national increases in life expectancy. Methods: A single center, retrospective analysis was performed at our institution. General surgical operations performed in nonagenarians from 1998 to 2008 were identified. Two to one controls were generated and matched for procedure and emergency status. Primary outcomes were early (30 day) and late (12 month) mortality. Two sample t-tests were used to compare several independent variables. These included length of stay, duration of operation, ejection fraction, and ASA (American Society of Anesthesiologists) score. Logistic regression was used to analyze associations between select independent variables and the outcomes of interest. Results: During the study period, 544 total procedures were performed in nonagenarians and of these 53(9.7%) were general surgical operations. Mean age of nonagenarians was 91.5 ± 1.76 (range 90 - 97) versus that of controls, 60.8 ± 15.8 (range 30 - 87).The most common operations were colorectal resection 23/53 (43.4%), hernia repair 13/53 (24.5%), exploratory laparotomy/ adhesiolysis 6/53 (11.3%), and small bowel resection 5/53 (9.4%). Nonagenarian and control groups were not significantly different with respect to duration of operation, length of stay, and ejection fraction. There was no significant difference in early mortality noted between nonagenarians and controls among all operations, 3/53 (5.6%) vs. 5/106 (4.7%) p=0.7991. There was a trend towards a significant difference in late mortality between nonagenarians and controls among all operations, 13/53 (25.5%) vs. 21/106 (19.8%) p=0.0567. Among nonagenarians with an elective operation (34/53; 64.1%), there was one early mortality (1/ 34; 2.9%) versus none in controls (0/68; 0%), and four late mortalities (4/32; 12.5%) in nonagenarians versus six (6/68; 8.8%) in controls (p=0.5676). Among nonagenarians with an emergent operation (19/53; 28.8%), there were two early mortalities (2/19; 10.5%) versus five in controls (5/37; 13.2%) (p=0.7489), and nine late mortalities (9/19; 47.4%) in nonagenarians versus ten (10/37; 26.3%) in controls (p=0.0473). Conclusion: General surgical operations in nonagenarians are reasonable, without increased early mortality, length of stay, or operative time. There is a significant difference in late mortality among emergent operations in nonagenarians compared with controls. However, general surgical operations, particularly those which are elective, are not prohibitive in nonagenarians.
W1495 First Experiences with Transvaginal Hybrid-NOTES Cholecystectomy Rene Fahrner, Matthias Turina, Renato Müller, Othmar Schoeb Introduction: Laparoscopic cholecystectomy has become standard procedure during the last two decades. Natural orifice transluminal endoscopic surgery (NOTES) will further decrease the operative trauma to the abdominal wall and reduce postoperative pain, wound infection, risk of hernia and hospital stay. We now report the first results of transvaginal HybridNOTES cholecystectomy from Switzerland. Methods und Materials: From July 2008 to October 2008, 4 women were treated by transvaginal Hybrid-NOTES cholecystectomy. Pneumoperitoneum was created through a 5 mm incision in the umbilicus. Two rigid trocars (12 mm and 5 mm) were inserted in the posterior fornix of the vagina. Patient data, operative time, complications and postoperative course were recorded prospectively in each patient. Results: The average age of the 4 patients was 33 years (19 to 44 years) and the mean body mass index was 25.73 kg/m2. One patient had in advance a cesarean section and another patient a conization. In all patients operation was performed without intraoperative complications and no further procedure was done simultaneously. The mean operative time was 77 minutes (65 to 87 minutes). The mean hospital stay was 2.75 days (2 to 3 days). Non steroidal anti-inflammatory drugs and paracetamol or metamizol were administered for postoperative analgesia. The postoperative course was except for little vaginal bleeding in the first 3 to 7 days uneventful. The further postoperative follow-up after 4 weeks was without complications. Discussion: The transvaginal Hybrid-NOTES cholecystectomy is a feasible and safe procedure. Operative time was despite lack of experience not longer than in laparoscopic cholecystectomy. The posterior colpotomy is a simple approach to the abdominal cavity and wound healing is very rapid. Using rigid instruments and techniques which are wellknown from laparoscopy, transvaginal cholecystectomy is possible without other medical specialties.
W1498 Surgical Treatment of Rectocele: Block vs Stapled Trans-Anal Rectal Resection (STARR) Vito M. Stolfi, Pierpaolo Sileri, Alessandro Falchetti, Chiara Micossi, Marco Venza, Achille Gaspari Background: The aim of this study is to compare Block technique and Stapled trans-anal rectal resection for treatment of symptomatic rectocele associated with Obstructed Defecation Syndrome (ODS). Patients and Methods: 32 patients (all female) entered the study. All patients underwent anorectal manometry, defecography, and colonoscopy. Sixteen patients were treated with Block technique (Group A); 16 patients were treated with STARR (Group B). The two groups were homogeneous for the presence of preoperative symptoms such as pain (p 0.923), bleeding (p 0.704), mucous discharge (p 0.273), urgency (p 0.219) and in all patients the main complain was ODS. Visual analogue scale (VAS) was used for pain evaluation, Student T-Test to analyze quantitative variables, Fisher's Exact Test for qualitative variables. Results: Hospital stay was respectively 2.7±1.8 days for Group A and 4±4.1 for Group B (p 0.27). Postoperative pain was significantly less in STARR compared to Block, 3.6±3.1 vs 4.8±3.2 respectively during the first five post-operative days (p 0.02). Pain duration in days was not different in the two groups: 13.6±13.2 Group B vs 13.9±15.9 Group A (p 0.950). The number of patients who had an improvement of ODS three months after surgery was 14 (87.5%) in both groups. Each patient was asked to quantify the percentage of improvement of ODS: the mean result was 67.5% improvement for Block vs 82% for STARR (p 0.19). We observed two major complications in Group B: one patient had severe retroperitoneal sepsis who required faecal diversion, the other had rectal bleeding requiring blood transfusions and Enterococcal infection requiring 1 months of antibiotic therapy; in Group A one patient had bleeding requiring blood transfusions. Conclusions: In this preliminary report comparing Block vs STARR technique for the treatment of rectocele postoperative pain was significantly less after STARR; although postoperative pain duration was not different. Hospital stay was longer in STARR but not significantly if compared with Block group. The improvement of ODS was present in 87.5% of patients in both groups and was similar quantified by the same patients. We report in one case treated with STARR
W1496 Registration of Health Related Quality of Life in Population-Based Cohort of Patients Undergoing Cholecystectomy Simon H. Pålsson, Gabriel Sandblom, Ib C. Rasmussen, Patrik Lundström, Johanna Österberg
Background: Gallstone surgery is one of the most common surgical procedures in Sweden. In order to assess the impact on quality of life from gallstone surgery, a reliable instrument with sufficient responsiveness is required.
Materials and methods: The Swedish Register
A-925
SSAT Abstracts
SSAT Abstracts
General Surgery in Nonagenarians: A Single Institution's Ten Year Experience G. Peter Fakhre, Jillian Bray, John Stauffer, Galen Perdikis, Sarah McLaughlin, Philip P. Metzger, Horacio J. Asbun, Steven P. Bowers, C. Daniel Smith
Background: Pancreatobiliary access following Roux en Y Gastric Bypass(RYGBP)is challenging. We present the largest series to date, evaluating 32 cases of surgical gastrostomy for endoscopic upper gastrointestinal endoscopy. Methods: Retrospective chart review of prospectively collected data on patients with history of previous RYGBP that between, 20042008, had laparoscopic or open gastrotomy for pancreatobiliary and duodenal access at a single institution. Data reviewed was indication for procedure, surgical findings, successful cannulation and complications. Results: Thirty patients (25 female) with age ranging from 27 to 72, underwent 32 procedures. The indications to access the gastric remnant were: 3 cholangitis, 13 sphincter of Oddi dysfunction, 5 common bile duct stone/obstruction, 6 pancreatitis, 1 cystic duct leak after cholecystectomy, 2 for pancreatic mass evaluation and 2 for gastrointestinal bleed. Mean operative time was 200 minutes(98-338), estimated blood loss, mean 85cc (10-500). 28 patients had laparoscopic gastrostomy with one conversion to open due to decreased visualization from gaseous distention of the small bowel after the ERCP and 4 open procedures. All 30 patients underwent successful cannulation, 28 had an ERCP, 2 patients had an EGD and 2 patients had an EUS. During surgical exploration 13 internal hernias were found in 10 patients: 7 Peterson hernias, 5 small bowel mesenteric defect and 1 transverse mesocolic defect. Surgical complications included: 1 patient had a wound infection at the gastrostomy tube site and 3 patients had to be re-explored. One had an abscess around the gastrostomy tube site and the other 2 patients had small amount of free fluid with no leak noted. Conclusions: Surgical gastrostomy is a safe and effective means to gain access to the upper GI tract following roux-en-Y gastric bypass. Given the incidence of unsuspected intra-abdominal hernias and the occasional need for open exploration, this procedure should be performed by experienced minimally invasive and pancreatobiliary surgeons.