Subject(s)
Feces , Intestinal Perforation/complications , Intestinal Volvulus/complications , Pneumothorax/etiology , Sigmoid Diseases/complications , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/therapy , Intestinal Volvulus/diagnosis , Intestinal Volvulus/therapy , Male , Middle Aged , Pneumothorax/diagnosis , Pneumothorax/therapy , Sigmoid Diseases/diagnosis , Sigmoid Diseases/therapyABSTRACT
INTRODUCTION: Laparoscopic bile duct exploration at the time of laparoscopic cholecystectomy has been promoted as being equally successful as endoscopic bile duct clearance. Further, if successful it offers the possibility of reducing the number of interventions required and therefore reducing overall costs. However, there is little in the literature that describe current treatment patterns in the Australian environment. METHODS: Medicare data were obtained for the number of patients undergoing laparoscopic cholecystectomy, intraoperative cholangiography, laparoscopic transcystic bile duct exploration, laparoscopic choledochotomy and bile duct exploration, endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy and endoscopic biliary stent insertion. RESULTS: Although there was significant state-to-state variation in the prevalence of laparoscopic bile duct exploration (0.6-3.7%), ERCP remained the predominant method of bile duct clearance in the setting of laparoscopic cholecystectomy (5.4%). Transcystic bile duct exploration is far more common than laparoscopic choledochotomy, which is a rare procedure. This suggests that patients with a dilated common bile duct and large or multiple stones are typically undergoing ERCP rather than laparoscopic bile duct clearance. CONCLUSION: Despite the apparent attractiveness of laparoscopic bile duct exploration at the time of cholecystectomy, ERCP remains the most common method of dealing with choledocholithiasis in the setting of an intact gallbladder in Australia.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Gallstones/diagnosis , Gallstones/surgery , Australia , Humans , Patient Selection , Practice Patterns, Physicians'/statistics & numerical data , Retrospective StudiesABSTRACT
BACKGROUND: Monash Medical Centre introduced the acute surgical unit (ASU) in July 2011. The ASU is modelled on the concept of acute care surgery (ACS). This study reviews the impact of the ASU on the outcomes in an appendicectomy population. METHODS: A retrospective review of all patients (aged 16-99 years) who underwent appendicectomies in the 2-year study time frame (from July 2010 to June 2012) at our centre was performed. The cohort (n = 539) was divided into two groups for analysis: the ASU group, patients admitted on or after 18 July 2011 (n = 283), and the control group, patients admitted prior to 18 July 2011 (n = 256). RESULTS: Median time to operation (1129 min versus 1080 min, P = 0.963) and negative appendicectomy rate (24.2% versus 24.8%, P = 0.871) were similar in both groups. The proportion of operations performed overnight (18.00-08.00 hours) was significantly decreased in the ASU group (17.1% versus 30.7%, P < 0.001). Perforation rate was marginally higher in the ASU group (17.8% versus 11.8%, P = 0.053) but failed to reach statistical significance. There was an increase in the usage of preoperative imaging (40.3% versus 30.5%, P = 0.018) in the ASU group. Operating times, length of stay, laparoscopic-to-open conversion and surgical site infection rates remained similar. CONCLUSION: We conclude that implementation of an ACS model does not lead to objective differences in outcome for patients after appendicectomy. However, the ACS model significantly decreased the number of operations performed after-hours.
Subject(s)
Appendectomy , Appendicitis/surgery , Emergency Service, Hospital/organization & administration , Models, Organizational , Surgery Department, Hospital/organization & administration , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy/statistics & numerical data , Appendicitis/diagnosis , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Surgery Department, Hospital/statistics & numerical data , Treatment Outcome , Unnecessary Procedures/statistics & numerical data , Young AdultABSTRACT
Although proctocolectomy and ileal pouch surgery is a routine part of modern-day management for complicated ulcerative colitis, these patients are often debilitated and require close and attentive management in the early postoperative period. Here we present a rare but clinically important postoperative complication.
