Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP.

PURPOSE: The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis. RESULTS: We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the  two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = - 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001). CONCLUSIONS: This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.

Effect of Alprazolam as a Preoperative Adjuvant Analgesic on Postoperative Pain in Laparoscopic Donor Nephrectomy Patients.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of alprazolam, administered at different doses, for the control of adjuvant analgesia in laparoscopic donor nephrectomy patients preoperatively in the Akdeniz University Organ Transplantation Center, using various pain scales. MATERIALS AND METHODS: Only patients with a body mass index ≤28 kg/m2, aged between 18 and 65 years old, and with an American Society of Anesthesiologists score of 1 to 2 were included in the study. The patients were studied in 3 groups, which were given 0.5 mg alprazolam (group 1), 1 mg alprazolam (group 2), or no alprazolam (group 3) in the preoperative period. Collected data were evaluated for preoperative, intraoperative, and postoperative periods. RESULTS: There were 75 patients (31 men, 44 women). Mean age was 43.1 years. Twenty-five patients were evaluated in all 3 groups. Mean operation time was 137.8 minutes. There was no statistical difference among the groups in the duration of administered alprazolam before the operation, on the Ramsey sedation score, verbal pain score, or numeric pain score, and duration of administered first analgesic in the postoperative period. Additional dose of analgesics were administered in 7, 7, and 11 of the patients in group 1, group 2, and group 3, respectively. We found a significant difference between groups 1 and 2 in blood pressure (P = .017 and P = .014). We found a significant difference in group 1 in heart rate (P = .002). CONCLUSION: More effective analgesia protocols need to be identified for pain control in patients of laparoscopic donor nephrectomy. It is thought that the effectiveness of pain control may increase the number of donors and progress in the treatment of patients with renal failure.

In Vitro Fertilization After Renal Transplantation: A Single-Center Experience.

INTRODUCTION: Although kidney transplantation often increases the chances of fertility, the rate of infertile patients is still high. In vitro fertilization promises successful results for infertile renal transplantation patients. The purpose of this study was to analyze the experience of a single center. METHODS: Patients were invited to complete a survey for their obstetric history. Documentation review included demographic and clinical characteristics of patients, like procedure records, follow-up complications, immunosuppression maintenance protocols, and pregnancy outcomes. RESULTS: Thirteen patients were reached to complete the survey. The mean age of patients was 33 ± 4 years at in vitro fertilization (IVF). The median duration of infertility was 2 years. Twenty-four IVF sessions were applied to these 13 women with renal transplantation. The procedure failed in 13 of these sessions; and 8 women achieved 11 clinical pregnancies. There were 3 miscarriages and 2 stillbirths. Six women had live births with no neonatal deaths. One patient had a graft rejection after the IVF procedure. Serum creatinine level increased more than 30% in 3 patients after the IVF procedure, while 9 patients had a minimal or no change. DISCUSSION: In our study, we evaluated the records of 13 patients with renal transplantation who had IVF procedures. Fortunately, more than half of these patients had live births with no neonatal deaths. In our opinion, our findings show that IVF procedures can be accepted as a promising method in patients with renal transplantation and need a therapy for fertility. Moreover, a 25% live-birth rate per procedure is also a satisfactory result.

Fertility Outcome After Renal Transplantation: A Single-Center Experience.

BACKGROUND: Women suffering from kidney disease are more prone to fertility problems, due to uremia. Fortunately, their fertility rate increases dramatically after renal transplantation. This study analyzes the predictors/risk factors of successful pregnancy with live birth outcome while presenting an overview of the 7-year experience of a single center. METHODS: This retrospective cohort study includes 239 women of reproductive age (18-40 years) who underwent renal transplantation in a tertiary Turkish clinic between October 1, 2011, and August 24, 2017. The subjects were invited to take part in a survey questioning their obstetric characteristics and they were assessed in 2 groups: fertile and infertile. Multivariable linear regression analysis was conducted to determine the predictors of a successful pregnancy. RESULTS: Thirty-five 35 patients wished to become pregnant: 12 got pregnant spontaneously, while 21 failed to become pregnant (spontaneously). The mean age of the patients at the survey was 34 ± 7. Regular menstrual cycles after renal transplantation, tacrolimus-mycophenolate mofetil maintenance protocol, and age at transplantation were found to be predictors of spontaneous pregnancy. The duration of peritoneal dialysis was significantly longer in the infertile group (48 vs 12 months). CONCLUSION: End-stage renal disease's negative impacts, including menstrual abnormality and fertility problems, can be overcome by successful kidney transplantation with appropriate immunosuppression. Minimizing the duration of peritoneal dialysis, particularly in patients who desire future fertility, may be accepted as a logical management strategy.

Quantitative assessment of the impacts of stoppa repair and total extraperitoneal repair on the lower extremity muscular functions in cases of unilateral inguinal hernia: a randomized controlled study.

PURPOSE: Choosing the best operative technique for unilateral inguinal hernia is a challenge for surgeons. Therefore, anticipating loss of strength in the lower extremity muscles could be the initial step to make the right decision. To this end, this prospective randomized controlled study compared the physical activity parameters of the lower extremity muscles in patients who underwent total extraperitoneal repair (TEP) and Stoppa repair. METHODS: Fifty patients with unilateral inguinal hernia who were 18-65 years of age were admitted to a single institution in a metropolitan city in Turkey. Patients were randomized in a 1:1 ratio to parallel study arms of TEP and STOPPA repair. They were evaluated in the preoperative period and on the postoperative day 3 for an objective isometric and isokinetic assessment of the pain-related functional changes in the lower extremity muscles. RESULTS: The measurement results obtained with the Cybex device on the postoperative day 3 were presented as numeric parameters in the digital setting, where the Stoppa repair resulted in a higher loss of strength in the lower extremities compared to the TEP repair. With respect to the total workforce loss in isokinetic muscular measurements at 90 °C/s extension, 90 °C/s flexion, 180 °C/s extension and 180 °C/s flexion, the difference between the TEP repair and Stoppa repair was statistically significant in favor of TEP repair (p < 0.05). CONCLUSION: This study is the first comparative study in the literature to demonstrate the favorable impact of the laparoscopic hernia repair on the physical activity on the same anatomic site compared to the open surgical procedure by using quantitative values. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02813057.