-
International Journal of Surgery... Jan 2016This study was performed to evaluate the effects of staple line reinforcement during laparoscopic sleeve gastrectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study was performed to evaluate the effects of staple line reinforcement during laparoscopic sleeve gastrectomy.
METHODS
Relevant articles published in English (up to July 25, 2015) were identified by searching PubMed, Embase, Web of Knowledge. The outcomes of staple line hemorrhage and leakage, overall complications, operative time were pooled. Data synthesis and statistical analysis were performed using Stata 13.1 software.
RESULTS
Eight randomized controlled trials involving 791 patients (453 cases and 338 controls) were analyzed. Compared to performing no reinforcement, staple line reinforcement was associated with a lower risk of staple line hemorrhage (RR = 0.609, 95%CI = 0.439-0.846, P = 0.003) and overall complications (RR = 0.673, 95%CI = 0.507-0.892, P = 0.006). No significant difference was observed regarding postoperative leakage (RR = 0.654, 95%CI = 0.275-1.555, P = 0.337). Oversewing of the staple line took longer operative time (WMD = 13.211, 95%CI = 6.192-20.229, P = 0.000).
CONCLUSION
Staple line reinforcement using buttressing or roofing materials could reduce staple line hemorrhage and overall complications. No obvious advantages of oversewing the staple line were found and it took longer operative time. No significant reduction in leak rate was evidenced after reinforcement.
Topics: Gastrectomy; Humans; Incidence; Laparoscopy; Operative Time; Postoperative Hemorrhage; Randomized Controlled Trials as Topic; Surgical Stapling
PubMed: 26700201
DOI: 10.1016/j.ijsu.2015.12.007 -
Scientific Reports Oct 2023It is important to identify risk factors for post-thyroidectomy bleeding requiring airway intervention or reoperation. Therefore, we aimed to compare the characteristics...
It is important to identify risk factors for post-thyroidectomy bleeding requiring airway intervention or reoperation. Therefore, we aimed to compare the characteristics of patients with postoperative bleeding after thyroid surgery according to the period until reoperation. We conducted a retrospective study analyzing data between April 2009 and July 2022 and included 126 patients who had postoperative bleeding. The patients were grouped according to the period between thyroidectomy and reoperation due to bleeding (0 day, 1-7 days, > 7 days). We performed among-group comparisons of patient characteristics and surgical aspects, including the extent of surgery. The ratios of male-female and lateral neck dissection were higher in the post-operative bleeding group than in the group without bleeding. In the analysis of patients with postoperative bleeding, grouped according to period between thyroidectomy and reoperation, there was a significant among-group difference in the male-female ratio. The male sex was positively correlated with the reoperation period. Further, the reoperation period was also positively correlated with total thyroidectomy and lateral neck dissection and the operation time showed a significant among-group difference. Our results indicate that the male sex and lateral neck dissection are risk factors for postoperative bleeding after thyroidectomy. Furthermore, male sex, total thyroidectomy, and lateral neck dissection are risk factors for delayed bleeding. Therefore, clinicians should consider these factors for interventions against immediate or delayed bleeding after thyroidectomy.
Topics: Humans; Male; Female; Thyroidectomy; Retrospective Studies; Thyroid Gland; Neck Dissection; Postoperative Hemorrhage; Thyroid Neoplasms
PubMed: 37884578
DOI: 10.1038/s41598-023-44323-z -
Clinical Otolaryngology : Official... Jan 2023To evaluate the analgesic and anti-haemorrhagic efficacy of platelet-rich plasma (PRP) among patients undergoing tonsillectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the analgesic and anti-haemorrhagic efficacy of platelet-rich plasma (PRP) among patients undergoing tonsillectomy.
DESIGN
A systematic review and meta-analysis of randomised controlled trials (RCTs).
SETTING
PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases were screened from inception until July 2021, and updated in December 2021.
PARTICIPANTS
Patients undergoing tonsillectomy.
MAIN OUTCOME MEASURES
The efficacy endpoints of postoperative pain and haemorrhage were summarised as standardised mean difference (SMD) and risk ratio (RR), respectively, with 95% confidence interval (CI).
RESULTS
Seven RCTs Seven RCTs were analysed, comprising a total of 392 patients. Risk of bias evaluation showed an overall high risk in one RCT, low risk in four RCTs and some concerns in two RCTs. The pooled results revealed that the mean postoperative pain score was significantly reduced in favour of the PRP group compared with the control group (SMD = -1.38, 95% CI [-1.91, -0.85], p < 0.001). Subgroup analysis showed the effect estimate was statistically significant for early postoperative pain (Day 0 to Day 3), without substantial difference between both groups on late postoperative pain (Days 5 and 7). Moreover, the rate of postoperative haemorrhage was significantly reduced in favour of the PRP group compared with the control group (RR = 0.16, 95% CI [0.05, 0.50], p = 0.001). Subgroup analysis showed the effect estimate was statistically significant for the rate of primary and secondary haemorrhage.
CONCLUSION
PRP was associated with significant reduction in postoperative pain and haemorrhage among patients undergoing tonsillectomy.
Topics: Humans; Tonsillectomy; Platelet-Rich Plasma; Analgesics; Pain, Postoperative; Postoperative Hemorrhage; Randomized Controlled Trials as Topic
PubMed: 36029195
DOI: 10.1111/coa.13977 -
Auris, Nasus, Larynx Apr 2022Transoral robotic surgery (TORS) is becoming widely used in Japan, and information on postoperative hemorrhage is needed. We treated a patient who developed a second...
Transoral robotic surgery (TORS) is becoming widely used in Japan, and information on postoperative hemorrhage is needed. We treated a patient who developed a second massive postoperative hemorrhage on Day 35 post-TORS. The 69-year-old man was diagnosed with p16-positive, T1N1M0 stage I cancer of the anterior wall of the oropharynx. Curative treatment began with right neck dissection. The external carotid artery and its branches were not ligated. One month after right neck dissection, TORS was conducted. On Day 23 post-TORS, the patient was brought to the emergency room due to pharyngeal bleeding. Hemorrhage was stopped by reclosing the site with Z-shaped silk sutures. Severe hemorrhage recurred on Day 35 post-TORS. The patient went into hemorrhagic shock. Tracheostomy was immediately performed. The neck dissection wound was then opened and the external carotid artery clamped. Hemostasis was confirmed transorally, but the hemorrhage site was again sutured with Z-shaped silk sutures to stop the bleeding. The patient was discharged on Day 58 post-TORS. Even in hindsight, this hemorrhage would have been difficult to prevent with better local treatment. This means that using transcervical arterial ligation together with TORS is appropriate from the perspective of making every effort to prevent potentially fatal postoperative hemorrhage.
Topics: Aged; Humans; Ligation; Male; Neck Dissection; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Postoperative Hemorrhage; Robotic Surgical Procedures
PubMed: 32950325
DOI: 10.1016/j.anl.2020.09.002 -
BMC Gastroenterology Nov 2023Ruptured aneurysm is a serious complication of distal pancreatectomy (DP) or pancreatoduodenectomy (PD) that can be life-threatening if not treated promptly. This study...
BACKGROUND
Ruptured aneurysm is a serious complication of distal pancreatectomy (DP) or pancreatoduodenectomy (PD) that can be life-threatening if not treated promptly. This study aimed to examine the efficacy of a Viabahn stent graft for stopping bleeding after pancreatectomy.
METHODS
Between April 2016 and June 2022, we performed 245 pancreatectomies in our institution. Six patients experienced postoperative bleeding and underwent endovascular treatment.
RESULTS
All six cases of bleeding occurred post-PD (3.7%). The bleeding was from gastroduodenal artery (GDA) pseudoaneurysms in three patients, and Viabahn stent grafts were inserted. All three patients did not show liver function abnormalities or hepatic blood flow disorders. One patient with a Viabahn stent graft experienced rebleeding, which required further management to obtain hemostasis. Of the six cases in which there was hemorrhage, one case of bleeding from the native hepatic artery could not be managed.
CONCLUSIONS
Using the Viabahn stent graft is an effective treatment option for postoperative bleeding from GDA pseudoaneurysms following PD. In most cases, using this device resulted in successful hemostasis, without observed abnormalities in hepatic function or blood flow.
Topics: Humans; Aneurysm, False; Endovascular Procedures; Pancreatectomy; Pancreaticoduodenectomy; Postoperative Hemorrhage; Retrospective Studies; Stents; Treatment Outcome
PubMed: 37936060
DOI: 10.1186/s12876-023-03022-9 -
European Journal of Anaesthesiology Mar 2020Heparin-associated coagulation disorder is an important factor related to postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass....
BACKGROUND
Heparin-associated coagulation disorder is an important factor related to postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Currently, the relationship between heparin sensitivity and postoperative bleeding is unknown.
OBJECTIVE
To investigate the relationship between individual heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery.
DESIGN
Prospective controlled study.
SETTING
Tertiary teaching hospital, Urumqi, Xinjiang, PR China. The study was conducted from January 2016 to August 2018.
PATIENTS
A total of 195 adult patients undergoing cardiac valve replacement surgery were included.
INTERVENTION
After initial heparin dosing (2.5 mg kg), patients were divided into three groups according to the whole blood activated clotting time (ACT): group A, insensitive group (ACT < 480 s); group B, sensitive group (480 s < ACT < 750 s); group C, hypersensitive group (ACT > 750 s).
MAIN OUTCOME MEASURES
First, intra-operative and 24-h postoperative blood loss. Second, antithrombin (AT) and factor X mRNA levels. Third, the plasma levels of AT-III and factor X. Fourth, heparin sensitivity index.
RESULTS
Blood loss was approximately 20 to 25% lower in group B than in groups A and C, which was statistically significant (P < 0.01). The AT-III mRNA levels increased from groups A to C and was positively associated with heparin sensitivity; the factor X mRNA levels changed in the opposite direction; a significant difference was observed between groups A and C (P < 0.05). The factor X plasma level showed the same trend as its mRNA. The AT-III plasma level was significantly lower in group B than in groups A and C (P < 0.05).
CONCLUSION
Postoperative blood loss is related to heparin sensitivity in patients undergoing cardiac surgery, and the moderately sensitive patients have the least postoperative bleeding. Individual variation in heparin sensitivity is related to the mRNA and plasma levels of AT-III and factor X.
TRIAL REGISTRATION
Registration number ChiCTR-RPC-17012259.
Topics: Adult; Anticoagulants; Cardiac Surgical Procedures; Cardiopulmonary Bypass; China; Heparin; Humans; Postoperative Hemorrhage; Prospective Studies; Whole Blood Coagulation Time
PubMed: 31895135
DOI: 10.1097/EJA.0000000000001148 -
JAMA Otolaryngology-- Head & Neck... Jul 2022Postthyroidectomy hemorrhage is a potentially life-threatening complication with no reliable noninvasive method of early detection.
IMPORTANCE
Postthyroidectomy hemorrhage is a potentially life-threatening complication with no reliable noninvasive method of early detection.
OBJECTIVE
To evaluate the diagnostic accuracy of neck circumference measurement for early detection of postoperative hemorrhage after thyroidectomy.
DESIGN, SETTING, AND PARTICIPANTS
This diagnostic accuracy study at an academic teaching hospital used a prospective cohort of patients undergoing thyroid surgery from November 1, 2015, to January 31, 2018 (group 1), and a retrospective cohort of patients undergoing the same surgery from January 1, 2020, to September 30, 2021 (group 2). We performed repeated perioperative neck circumference measurements to evaluate the association of increased neck circumference with postthyroidectomy hemorrhage among patients at risk for hemorrhage.
MAIN OUTCOMES AND MEASURES
The primary end point was the diagnostic value of neck circumference measurement for detection of postthyroidectomy hemorrhage. Additionally, data on demographic information and risk factors for postthyroidectomy hemorrhage were examined. Data analyses were performed from November 1, 2021, to January 5, 2022.
RESULTS
The prospective cohort (group 1) comprised 60 patients (45 [75%] women) with a mean (SD) age of 52.2 (13.5) years; those who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 57.4 (9.0) years. The retrospective cohort (group 2) comprised 353 patients (258 [73%] women) with a mean (SD) age of 55.3 (14.1) years; patients who experienced a postthyroidectomy hemorrhage had a mean (SD) age of 62.2 (10.0) years. In group 1, postoperative neck circumference increased by a median (range) of 5.0 (4.0 to 7.0) cm in patients with hemorrhage, and only 1.0 (-2.5 to 4.0) cm in patients with no postoperative bleeding (difference in the medians, 4.0 cm [95% CI, 3.0 to 5.5 cm]; effect size, 3.74 [95% CI, 2.6 to 4.9]). Defining a 7% or greater increase in neck circumference as the cutoff value for detecting postthyroidectomy hemorrhage showed a diagnostic sensitivity and specificity of 1.0 (95% CI, 0.48 to 1.0) and 0.86 (95% CI, 0.71 to 0.92), respectively. The retrospective validation also showed a difference in median (range) increase of postoperative neck circumference between patients with hemorrhage and those without-3.0 (0 to 6.0) cm vs 0.0 (-6.0 to 5.0) cm (difference in medians, 3.8 cm [95% CI, 3.0 to 4.9]; effect size, 1.63 [95% CI, 0.96 to 2.3]). Considering 12 false-positive and 332 correct-negative results, the diagnostic tool showed a sensitivity of 0.89 (95% CI, 0.51 to 0.99) and a specificity of 0.97 (95% CI, 0.94 to 0.98).
CONCLUSIONS AND RELEVANCE
The findings of this diagnostic accuracy study suggest that neck circumference measurement is a feasible and easy-to-use diagnostic tool for routine clinical care to detect postthyroidectomy hemorrhage. A 7% or greater increase over the postoperative baseline neck circumference seems to be a reliable threshold for detecting postthyroidectomy hemorrhage. Neck circumference measurement should be used in combination with surveillance of clinical signs and symptoms.
Topics: Female; Humans; Male; Middle Aged; Neck; Postoperative Hemorrhage; Prospective Studies; Retrospective Studies; Thyroidectomy
PubMed: 35679063
DOI: 10.1001/jamaoto.2022.1180 -
Scandinavian Journal of Surgery : SJS :... Mar 2017Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of... (Observational Study)
Observational Study
BACKGROUND AND AIMS
Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center.
MATERIALS AND METHODS
A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria.
RESULTS
A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy.
CONCLUSION
Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.
Topics: Aged; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Incidence; Logistic Models; Male; Middle Aged; Pancreatectomy; Postoperative Hemorrhage; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 26929287
DOI: 10.1177/1457496916631854 -
World Journal of Surgery May 2022Delayed bleeding after pancreaticoduodenectomy (PD) is a life-threatening complication. However, the optimal management remains unclear. We summarize our experience of...
BACKGROUND
Delayed bleeding after pancreaticoduodenectomy (PD) is a life-threatening complication. However, the optimal management remains unclear. We summarize our experience of the management of delayed bleeding after PD and define the outcomes associated with different types of management.
METHODS
All patients who underwent a PD between January 1987 and June 2020 at Johns Hopkins University were retrospectively reviewed. Delayed bleeding was defined as bleeding on or after postoperative day 5 following PD. Incidence, outcomes, and trends were reported.
RESULTS
Among the 6201 patients that underwent PD, delayed bleeding occurred in 130 (2.1%) at a median of 12 days (IQR: 9, 24) postoperation. The pattern of bleeding was classified as intraluminal (51.5%), extraluminal (40.8%), and mixed (7.7%). A clinically relevant postoperative pancreatic fistula and an intraabdominal abscess preceded the delayed bleeding in 43.1% and 31.5% of cases, respectively. Arterial pseudoaneurysm or bleeding from peripancreatic vessels was the most common reason (54.6%) with the gastroduodenal artery being the most common source (18.5%). Endoscopy, angiography, and reoperation were performed as a first-line approach in 35.4%, 52.3%, and 6.2% of patients, respectively. The overall mortality was 16.2% and decreased over the study period (p < 0.01).
CONCLUSIONS
Delayed bleeding following PD remains a life-threatening complication. The most common location of delayed bleeding is from the gastroduodenal artery. Angiography with embolization should be the initial approach for urgent bleeding with surgical re-exploration reserved for unstable patients or failed control of bleeding after interventional angiography or endoscopy.
Topics: Hepatic Artery; Humans; Incidence; Pancreaticoduodenectomy; Postoperative Hemorrhage; Retrospective Studies
PubMed: 35084554
DOI: 10.1007/s00268-022-06451-x -
Orbit (Amsterdam, Netherlands) Apr 2021Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital...
Periorbital hemorrhage is a potentially sight threatening surgical complication. The effect of new oral anticoagulants (NOACs) on hemorrhagic events after periorbital surgery has not been investigated. We describe four cases of severe delayed postoperative hemorrhage associated with NOACs, in addition to three cases in patients on traditional antithrombotic agents. Time of delayed hemorrhage ranged from postoperative day 2 to 6. Six patients required surgical intervention to achieve control of bleeding, and two patients required transfusion of blood products. Risk factors and management of this rare complication are discussed.
Topics: Administration, Oral; Anticoagulants; Humans; Postoperative Hemorrhage; Risk Factors
PubMed: 32295502
DOI: 10.1080/01676830.2020.1752744