ABSTRACT
Obturator hernia is an extremely rare pelvic hernia which occurs mostly in elderly, thin, multiparous women. Clinical manifestations are abdominal pain and/or unexplained intestinal obstruction, and obturator neuralgia due to compressed obturator nerve. As the lack of specific symptoms and external masses likes other abdominal wall hernias, its diagnosis may be arduous and difficult; hence, an accurate preoperative diagnosis or surgical treatment is often delayed, such a delay often leads to gangrenous bowel in a large proportion of cases and results in unacceptably high morbidity and mortality. preoperative detection of the obturator hernia due to clinical alert and in-time computed tomography of the pelvis. Early diagnosis and prompt initiation of surgical intervention are essential for this rare entity. This explanatory review emphasizes and illuminates its various facets under the significant events, anatomy, epidemiology and rationale of its diagnosis and management to familiarize surgeons with the condition that seldom thought of and hence seldom sought.
ABSTRACT
Obturator hernia is an extremely rare pelvic hernia which occurs mostly in elderly,thin,multiparous women.Clinical manifestations are abdominal pain and/or unexplained intestinal obstruction,and obturator neuralgia due to compressed obturator nerve.As the lack of specific symptoms and external masses likes other abdominal wall hernias,its diagnosis may be arduous and difficult;hence,an accurate preoperative diagnosis or surgical treatment is often delayed,such a delay often leads to gangrenous bowel in a large proportion of cases and results in unacceptably high morbidity and mortality,preoperative detection of the obturator hernia due to clinical alert and in-time computed tomography of the pelvis.Early diagnosis and prompt initiation of surgical intervention are essential for this rare entity.This explanatory review emphasizes and illuminates its various facets under the significant events,anatomy,epidemiology and rationale of its diagnosis and management to familiarize surgeons with the condition that seldom thought of and hence seldom sought.
ABSTRACT
Objective To investigate the clinical outcome before and immediately after implementation of fast track surgery protocol on patients with gastric cancer.Methods One hundred and thirty patients with gastric cancer in our hospital underwent an elective,uncomplicated,open gastric surgery before (Traditional care group,n =65) and immediately after implementing fast track surgery (Fast track surgery group,n =65).Postoperative food and fluid intake,mobilization,length of hospital stay,and clinical outcome were recorded and analysed,and a interview-based assessment was performed on days 14 and 30 postoperatively.Results Patients implemented fast track surgery were associated with a significantly earlier resumption of mobilization and oral fluids and normal diet,shorter duration of intravenous infusion compared with traditional care patients 0.3 (0-1) d vs 3.3 (2-4) d,0.2(0-1) d vs 3.5(3-4) d,3.3(3-4) d vs 5.6(5-6) d,3.4(3-4) d vs 5.2(5-6) d; P=0.000,respectively.Postoperative hospital stay was also shorter in fast track surgery group 6.6 (6-8) d vs 8.6 (8-9) d ; P =0.000.Instrumental activities of daily living decreased in both groups on day 14,but significantly more in the traditional care group,despite having a higher preoperative instrumental activities of daily living level compared with the fast track surgery group 5.0 (3-6) vs 3.0 (3-5),4.0 (3-6) vs 3.0 (3-5) ; P =0.000,respectively.Preoperative fatigue score was not different between two groups,but the fatigue score was significantly increased on day 14,and returned to normal value on day 30 in the traditional care group 2.0 (1-5) vs 3.0 (1-5),2.0(1-5) vs 2.0(1-6) ; P =0.005,P =0.065.Total length of sleep on day 14 was increased significantly in the traditional care group,but not changed in the fast track surgery group compared with preoperative value 9.0 (6-11) vs 8.0(5-10) h,8.0(5-11) vs 8.0(6-10) h; P=0.000,P=0.327.Conclusions A fast track surgery protocol can lessen postoperative stress reactions and enhance recovery for patients with gastric cancer undergoing an elective,uncomplicated,open resection.
ABSTRACT
ObjectiveToevaluatelaparoscopiccholecystectomy(LC)versusopen cholecystectomy (OC) in compensated cirrhotics and model for end-stage liver disease (MELD) score and Child-Turcotte-Pugh (CTP)classification in predicting perioperative morbidity.MethodsBetween January 1998 and June 2011,128 cirrhotic patients of symptomatic innocuous gallbladder disease at CPT class A or B liver function were prospectively and randomly divided into LC group (64 patients) and OC group (64 patients ). Data were analyzed by T test, Mann-Whitney U test and Pearson x2 test.ResultsThere was no statistical differences in operation time between the two groups ( t =1.761,P =0.081 ).The intraoperative blood loss ＞ 200 ml occurred in 15 ( 26％ ) LC patients and 35 ( 55％ ) OC patients ( x2 =4.467,P =0.035 ).LC patients had earlier up and about,earlier oral intake,short hospital stay ( t =5.424,t =8.573,t =15.634; P =0.000,respectively) and lower complication rate [ CTP:24％ (14/58) vs 38％ (24/64),x2 =4.582,P =0.032; MELD scores 21％ (12/58) vs 34％ (22/64),x2 =4.238,P =0.040] compared with OC patients.LC patients' VAS- fatigue and VAS-pain scores on first 3 days were lower than OC according to the VAS (visual analogue scale) (Mann-Whitney U =473.0,MannWhitney =6.0,Mann-Whitney =22.5,Mann-Whitney =24.0,Mann-Whitney =46.0; P =0.000,respectively),and the VRS-cosmetic score was higher in LC group than in the OC group according to the VRS ( verbal rating scale) ( Mann-Whitney =145.0,P =0.000).MELD score ＞ 14 predicted higher blood loss and complication rate regardless of LC or OC,while CPT classification did not seem to predict intraoperative bleeding volume and morbidity.ConclusionsLC can be performed safely in cirrhotic patients with CPT class A and B.LC has less,blood loss lower postoperative complication rate,and quicker postoperative recovery.MELD score system is more valuable than CPT classification system in predicting blood loss and postoperative complication rate in cirrhotics undergoing cholecystectomy.