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Sichuan Da Xue Xue Bao. Yi Xue Ban =... May 2022Endoscopic submucosal dissection (ESD) has been widely used in the clinical treatment of early-stage and precancerous lesions of the digestive tract. Compared with... (Review)
Review
Endoscopic submucosal dissection (ESD) has been widely used in the clinical treatment of early-stage and precancerous lesions of the digestive tract. Compared with traditional open surgery, the procedure has a number of advantages, including low postprocedural recurrence rate, the location and scope of lesions not posing much restrictions on the procedure, and quick patients recovery afterwards. The procedure has hence become one of the minimally-invasive procedures commonly performed with gastrointestinal endoscope. However, due to the influence of various factors, complications such as intraoperative and postoperative bleeding, perforation, electrocoagulation syndrome and lumen stenosis may occur. Delayed postoperative bleeding, in particular, may induce cardiovascular and other related diseases due to the insidious nature of its onset, resulting in serious consequences. It is critically important for the further development of ESD that we should acquire thorough understanding and mastery of the relevant influencing factors and preventive measures of delayed bleeding after ESD of early-stage gastrointestinal cancer. We herein summarized and discussed the latest research findings in the preventative and treatment measures.
Topics: Dissection; Endoscopic Mucosal Resection; Gastrointestinal Neoplasms; Humans; Postoperative Hemorrhage; Retrospective Studies
PubMed: 35642142
DOI: 10.12182/20220560503 -
Neurosurgery Jul 2023Postoperative hemorrhage is a rare but potentially serious complication after pituitary surgery. The risk factors for this complication are mostly unknown, and further...
BACKGROUND
Postoperative hemorrhage is a rare but potentially serious complication after pituitary surgery. The risk factors for this complication are mostly unknown, and further knowledge would help guide postoperative management.
OBJECTIVE
To investigate the perioperative risks and clinical presentation of significant postoperative hemorrhage (SPH) after endonasal surgery for pituitary neuroendocrine tumors.
METHODS
A population of 1066 patients undergoing endonasal (microscopic and endoscopic) surgery for pituitary neuroendocrine tumor resection at a high-volume academic center was reviewed. SPH cases were defined as postoperative hematoma evident on imaging requiring return to the operating room for evacuation. Patient and tumor characteristics were analyzed with uni- and multivariable logistic regression, and postoperative courses were descriptively examined.
RESULTS
Ten patients were found to have SPH. On univariable analysis, these cases were significantly more likely to present with apoplexy ( P = .004), have larger tumors ( P < .001), and lower gross total resection rates ( P = .019). A multivariate regression analysis showed that tumor size (odds ratio 1.94, P = .008) and apoplexy at presentation (odds ratio 6.00, P = .018) were significantly associated with higher odds of SPH. The most common symptoms for patients with SPH were vision deficits and headache, and the median time for symptom onset was 1 day after surgery.
CONCLUSION
Larger tumor size and presentation with apoplexy were associated with clinically significant postoperative hemorrhage. Patients presenting with pituitary apoplexy are more likely to experience a significant postoperative hemorrhage and should be carefully monitored for headache and vision changes in the days after surgery.
Topics: Humans; Case-Control Studies; Neuroendocrine Tumors; Retrospective Studies; Pituitary Neoplasms; Postoperative Hemorrhage; Risk Factors; Headache; Stroke
PubMed: 36794944
DOI: 10.1227/neu.0000000000002404 -
The Journal of Laryngology and Otology May 2022Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial...
OBJECTIVE
Post-operative bleeding is one of the most common and severe complications of turbinate surgery. This study compared post-operative bleeding following partial turbinectomy, submucosal turbinate reduction and endoscopic turbinoplasty.
METHODS
Post-operative bleeding was assessed in patients who underwent inferior turbinate intervention by partial turbinectomy, submucosal turbinate reduction or endoscopic turbinoplasty between January 2016 and November 2017 and had completed at least one month of follow up.
RESULTS
Of 1035 patients who underwent inferior turbinate surgery during the study period, 751 were included. Of these, 56 (7.5 per cent) presented to the emergency room with post-operative bleeding; 31 (8.4 per cent) had undergone partial turbinectomy, 19 (10.7 per cent) had undergone submucosal turbinate reduction and 6 (3.0 per cent) had undergone endoscopic turbinoplasty. The odds ratio of requiring an intervention to control bleeding was significantly lower in the endoscopic turbinoplasty group than in the submucosal turbinate reduction group (odds ratio = 3.26, 95 per cent confidence interval = 1.02-10.43).
CONCLUSION
Endoscopic turbinoplasty had the lowest rate of post-operative bleeding and the lowest rate of patients requiring intervention.
Topics: Endoscopy; Humans; Hypertrophy; Nasal Obstruction; Postoperative Hemorrhage; Rhinoplasty; Treatment Outcome; Turbinates
PubMed: 34702378
DOI: 10.1017/S0022215121003297 -
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 -
Turkish Neurosurgery 2023To assess the role of topical administration of tranexamic acid (TXA) on intraoperative and postoperative blood loss of patients undergoing posterior cervical...
Effect of Topical Administration of Tranexamic Acid on Intraoperative and Postoperative Blood Loss during Posterior Cervical Laminectomy and Fusion Surgery: A Retrospective Study.
AIM
To assess the role of topical administration of tranexamic acid (TXA) on intraoperative and postoperative blood loss of patients undergoing posterior cervical laminectomy and lateral mass screw ?xation (PCLF) compared to a control group.
MATERIAL AND METHODS
The data of 88 patients that underwent PCLF surgery, including 41 females and 47 males, were included in this retrospective study. Data elements including intraoperative blood loss (IBL), postoperative blood loss (PBL), amount of blood transfusion, surgical time, use of hemostatic agents, length of hospital stay, and time to return to work were extracted from medical records and compared between those who received topical TXA during surgery (irrigation of the surgical field with a solution of 3 g TXA in 100 ml normal saline) and an age- and sex-matched control group.
RESULTS
There were 48 patients in the TXA group and 40 patients in the control group. There were no significant differences in the baseline measurements and the level of operation between the two groups. The results showed that IBL and PBL were significantly lower in the TXA group compared to the control group (p=0.03 and p < 0.01, respectively). There were no significant differences in the need for blood transfusion, surgical time, and hospital stay between the two groups (p > 0.05). Moreover, the use of hemostatic materials during surgery and the time to return to work were significantly lower in the topical TXA group (p=0.04 and p < 0.01, respectively).
CONCLUSION
Topical TXA efficiently reduces intraoperative and postoperative bleeding in patients undergoing posterior cervical laminectomy and PCLF surgery. These results need further investigation in future studies to draw a definite conclusion.
Topics: Male; Female; Humans; Tranexamic Acid; Retrospective Studies; Laminectomy; Antifibrinolytic Agents; Treatment Outcome; Postoperative Hemorrhage; Blood Loss, Surgical; Hemostatics; Administration, Topical
PubMed: 36066061
DOI: 10.5137/1019-5149.JTN.37389-21.2 -
The Journal of International Medical... Oct 2019This study was performed to compare the intraoperative and postoperative courses of coblation tonsillectomy and coblation tonsillectomy with ties in adults. (Comparative Study)
Comparative Study
OBJECTIVE
This study was performed to compare the intraoperative and postoperative courses of coblation tonsillectomy and coblation tonsillectomy with ties in adults.
METHODS
All patients who underwent tonsillectomy from July 2012 to September 2016 were retrospectively reviewed. Intraoperative and postoperative bleeding, pain, and return to normal food intake were compared between patients who underwent coblation tonsillectomy and those who underwent coblation tonsillectomy with ties.
RESULTS
Of 515 patients, 300 (58.3%) underwent coblation tonsillectomy and 215 (41.7%) underwent coblation tonsillectomy with ties. Twenty-five (4.9%) patients developed postoperative hemorrhage, 22 (88.0%) of whom had undergone coblation tonsillectomy and 3 (12.0%) of whom had undergone coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy reported less pain than those who underwent coblation tonsillectomy with ties. Patients who underwent coblation tonsillectomy with ties resumed a normal diet significantly later than those who underwent coblation tonsillectomy (10.0 ± 3.2 vs. 8.2 ± 1.9 days, respectively).
CONCLUSION
Coblation tonsillectomy is associated with less intraoperative bleeding, a shorter surgery time, less postoperative pain, and fewer days to recovery of a normal diet than is coblation tonsillectomy with ties. However, coblation tonsillectomy with ties is associated with remarkably reduced postoperative hemorrhage.
Topics: Adult; Feeding Behavior; Female; Humans; Male; Pain, Postoperative; Postoperative Hemorrhage; Survival Analysis; Tonsillectomy
PubMed: 31456472
DOI: 10.1177/0300060519867822 -
The New England Journal of Medicine May 2022
Topics: Hemorrhage; Humans; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Risk Assessment; Risk Factors; Surgical Procedures, Operative
PubMed: 35613026
DOI: 10.1056/NEJMe2204599 -
Tidsskrift For Den Norske Laegeforening... Mar 2021
Topics: Humans; Pain, Postoperative; Palatine Tonsil; Postoperative Hemorrhage
PubMed: 33754674
DOI: 10.4045/tidsskr.21.0127 -
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 -
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