Preoperative incidence of olfactory dysfunction in nasal surgery patients.

OBJECTIVE: Learn the incidence of olfactory dysfunction in preoperative patients prior to nasal surgery and compare with a control group of patients who are not going to have such surgery. Assess the usefulness of the coffee/tea differentiation test in assessing preoperative dysosmia. STUDY DESIGN: Prospective controlled cohort study. SETTING: Urban medical center. SUBJECTS AND METHODS: One hundred fifty-one adult patients (aged 18-65 years) whose olfactory function was tested using the Pocket Smell Test and a coffee/tea differentiation test. A failed test required missing at least 1 item on the card or failure to report a difference between tea and coffee. The statistical analysis using the t test and the Fisher exact test were calculated using MINITAB. RESULTS: The study group (n = 55) had 38% men and 62% women compared with 58% men and 42% women in the control group (n = 96). The incidence of dysosmia was 32% in the study group and 14% in the control group. In the study group, 34.5% of patients failed the Pocket Smell Test and 12.4% failed the coffee/tea differentiation test as compared with 12.4% and 0%, respectively, in the control group. CONCLUSION: Patients who are scheduled for nasal surgery for medical or cosmetic indications are more likely to suffer from olfactory dysfunction before surgical intervention. This should be taken into consideration when counseling patients regarding possible postoperative complications.

Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery.

BACKGROUND: Although laparoscopy now plays a major role in most general surgical procedures, little is known about the relative risk of venous thromboembolism (VTE) after laparoscopic compared with open procedures. OBJECTIVE: To compare the incidence of VTE after laparoscopic and open surgery over a 5-year period. PATIENTS AND INTERVENTIONS: Clinical data of patients who underwent open or laparoscopic appendectomy, cholecystectomy, antireflux surgery, and gastric bypass between 2002 and 2006 were obtained from the University HealthSystem Consortium Clinical Database. The principal outcome measure was the incidence of venous thrombosis or pulmonary embolism occurring during the initial hospitalization after laparoscopic and open surgery. RESULTS: During the 60-month period, a total of 138,595 patients underwent 1 of the 4 selected procedures. Overall, the incidence of VTE was significantly higher in open cases (271 of 46,105, 0.59%) compared with laparoscopic cases (259 of 92,490, 0.28%, P < 0.01). Our finding persists even when the groups were stratified according to level of severity of illness. The odds ratio (OR) for VTE in open procedures compared with laparoscopic procedures was 1.8 [95% confidence interval (CI) 1.3-2.5]. On subset analysis of individual procedures, patients with minor/moderate severity of illness level who underwent open cholecystectomy, antireflux surgery, and gastric bypass had a greater risk for developing perioperative VTE than patients who underwent laparoscopic cholecystectomy (OR: 2.0; 95% CI: 1.2-3.3; P < 0.01), antireflux surgery (OR: 24.7; 95% CI: 2.6-580.9; P < 0.01), and gastric bypass (OR: 3.4; 95% CI: 1.8-6.5; P < 0.01). CONCLUSIONS: Within the context of this large administrative clinical data set, the frequency of perioperative VTE is lower after laparoscopic compared with open surgery. The findings of this study can provide a basis to help surgeons estimate the risk of VTE and implement appropriate prophylaxis for patients undergoing laparoscopic surgical procedures.

Laparoscopic and thoracoscopic Ivor Lewis esophagectomy with colonic interposition.

Minimally invasive esophagectomy is a feasible and safe alternative to open esophagectomy. The stomach is the preferred conduit for gastrointestinal reconstruction after esophagogastrectomy; however, if the stomach is not usable, the colon can be interposed as an alternative conduit. We describe the technique of minimally invasive Ivor Lewis esophagogastrectomy in a patient with a gastric cardia cancer involving the gastric body and distal esophagus. Laparoscopic colonic interposition using the right colon based on the middle colic vessels was used to restore gastrointestinal continuity.

Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers.

BACKGROUND: A large outcome study of laparoscopic gastric bypass has not been done because of difficulty in differentiating between open and laparoscopic procedures in the absence of a specific ICD-9 procedural code for the laparoscopic operation. The University HealthSystem Consortium (UHC) clinical database recently added a specific procedural code for laparoscopic gastric bypass. The goal of this study was to compare the use and outcomes of laparoscopic versus open gastric bypass at academic centers. STUDY DESIGN: Using ICD-9 diagnosis and procedure codes, we obtained data from the UHC clinical database for all patients who underwent laparoscopic or open Roux-en-Y gastric bypass for treatment of morbid obesity between 2004 and 2006 (n = 22,422). The main outcomes measures were demographics, comorbidities, length of hospital stay, 30-day readmission, morbidity, observed and expected (risk-adjusted) mortality, and costs. RESULTS: There were 16,357 patients who underwent laparoscopic gastric bypass and 6,065 patients who underwent open gastric bypass. Laparoscopic gastric bypass patients had a shorter length of hospital stay (2.7 days versus 4.0 days, p < 0.01); lower overall complications (7.4% versus 13.0%, p < 0.01); lower rates of pneumonia, venous thrombosis, leak, wound infection, and pulmonary complications; costs were also lower. The observed-to-expected in-hospital mortality ratio was similar between groups (1.0 versus 1.0). CONCLUSIONS: This nationwide analysis of academic medical centers between 2004 and 2006 showed that bariatric surgery has shifted to a predominately laparoscopic approach. In addition, laparoscopic gastric bypass is as safe as open gastric bypass and is considerably associated with a lower 30-day morbidity.

Minimally invasive management of intrathoracic leaks after esophagogastrectomy.

Enthusiasm for minimally invasive esophagectomy is increasing. When feasible, the laparoscopic and thoracoscopic Ivor Lewis esophagogastrectomy with construction of an intrathoracic anastomosis is favored. A potential catastrophic consequence of an intrathoracic anastomosis is a postoperative leak. In this review, the authors summarize the current understanding of the pathophysiology and the management of intrathoracic leak using minimally invasive surgical techniques.