Predictive Factors for a Long Hospital Stay in Patients Undergoing Laparoscopic Cholecystectomy.

Background. Although the advantages of laparoscopic cholecystectomy (LC) over open cholecystectomy are immediately obvious and appreciated, several patients need a postoperative hospital stay of more than 24 hours. Thus, the predictive factors for this longer stay need to be investigated. The aim of this study was to identify the causes of a long hospital stay after LC. Methods. This is a retrospective cohort study with 500 successful elective LC patients being included in the analysis. Short hospital stay was defined as being discharged within 24 hours after the operation, whereas long hospital stay was defined as the need for a stay of more than 24 hours after the operation. Results. Using multivariable analysis, ten independent predictive factors were identified for a long hospital stay. These included patients with cirrhosis, patients with a history of previous acute cholecystitis, cholangitis, or pancreatitis, patients on anticoagulation with warfarin, patients with standard-pressure pneumoperitoneum, patients who had been given metoclopramide as an intraoperative antiemetic drug, patients who had been using abdominal drain, patients who had numeric rating scale for pain > 3, patients with an oral analgesia requirement > 2 doses, complications, and private ward admission. Conclusions. LC difficulties were important predictive factors for a long hospital stay, as well as medication and operative factors.

Combination of etoricoxib and low-pressure pneumoperitoneum versus standard treatment for the management of pain after laparoscopic cholecystectomy: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Postoperative pain is one of the significant problems in laparoscopic surgery, especially during the first 6-12 h. This randomized controlled trial aimed to investigate the effect of combined preemptive etoricoxib 120 mg and low-pressure pneumoperitoneum for the management of pain after laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: One hundred and twenty patients aged 18-75 with American Society of Anesthesiologists class I-II who were candidates for elective LC were recruited into the study. The patients were randomly divided into two groups, by 'block of four' randomization. The treatment group received preemptive etoricoxib 120 mg and intraabdominal pressure of 7 mmHg, and the control group received placebo and intraabdominal pressure of 14 mmHg. The postoperative pain score at rest was recorded utilizing a numeric rating scale at 1, 2, 6, 10, 14, 18, 22, and 24 h. Pain on movement/ambulation (cough) was also recorded at 6, 10, 14, 18, 22, and 24 h. RESULTS: There were no significant differences in the baseline characteristics of the two groups. The pain scores of the treatment versus control group of abdominal pain and incisional pain were significant on movement. Abdominal pain scores of the treatment group were decreased 0.98 when compared with the control group (p = 0.017), and incisional pain scores were also decreased 0.99 (p = 0.001). The incidences of postoperative shoulder/back pain were statistically significant: 41.8 % vs. 66.7 % in the treatment and control group, respectively (p = 0.009). The postoperative hospital stay in the treatment group and control group was: 1 day = 96.4 and 75.0 %, >1 day = 3.6 and 25.0 %, respectively (p = 0.001). CONCLUSIONS: A combination of preemptive etoricoxib and low-pressure pneumoperitoneum had significant effects in decreasing overall pain and the incidence of shoulder/back pain after LC and also shortened the hospital stay. CLINICAL TRIALS REGISTRATION NUMBER: TCTR20140213001.

Metoclopramide, versus its combination with dexamethasone in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) are significant problems in laparoscopic surgery. OBJECTIVE: Compare the prophylactic use of metoclopramide and its combination with dexamethasone in the prevention of PONV in patients undergoing laparoscopic cholecystectomy (LC). MATERIAL AND METHOD: One hundred patients aged 18 to 75 with American Society of Anesthesiologists (ASA) class 1-2 who candidates for elective LC at Chiang Mai University Hospital, were included in this double-blind, randomized controlled trial (parallel design). Patients were randomly divided into two groups, by 'Block offour 'randomization. Treatment group received 8 mg dexamethasone and 10 mg metoclopramide, and control group received 10 mg metoclopramide and normal saline solution 1.6 ml. These medications were administered intravenously when the gallbladder was removedfrom gallbladder bed. All of investigators, anesthetists, patients, care providers, and outcome assessor were blinded. Patients were asked to assess their nausea and vomiting at 2, 6, 12, and 24 hours postoperatively, and at discharge. The overall score of PONV in each patient based on afour-point whole number of nausea and vomiting by verbal rating scale 0-3 (0 = no nausea and vomiting, 1 = nausea, 2 = nausea with vomiting, and 3 = repeated vomiting >2 times). RESULTS: Fifty eligible patients were randomized to each group, and all were analyzed. There were no significant differences between baseline characteristics of patients in the two groups. The combination of dexamethasone and metoclopramide indicated a greater antiemetic effect with significant statistical analysis, odds ratio = 0.25 (95% confidence interval O. 11-0.55, p = 0.001). Thepostoperative hospital stay in the combined group and metoclopramide group were, 1 day = 47 (94%) and 37 (74%), >1 day = 3 (6%) and 13 (26%), respectively (p = 0.012). There were no postoperative complications occurred in both groups. CONCLUSION: Intravenous administration of dexamethasone combined with metoclopramide had significant effects in prophylaxis of nausea and vomiting after LC and shorten the hospital stay. Clinical trials registration number: TCTR20140128001

Bariatric surgery in Asia in the last 5 years (2005-2009).

Obesity is a major public health concern around the world, including Asia. Bariatric surgery has grown in popularity to combat this rising trend. An e-mail questionnaire survey was sent to all the representative Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) members of 12 leading Asian countries to provide bariatric surgery data for the last 5 years (2005-2009). The data provided by representative members were discussed at the 6th International APMBSS Congress held at Singapore between 21st and 23rd October 2010. Eleven nations except China responded. Between 2005 and 2009, a total of 6,598 bariatric procedures were performed on 2,445 men and 4,153 women with a mean age of 35.5 years (range, 18-69years) and mean BMI of 44.27 kg/m(2) (range, 31.4-73 kg/m(2)) by 155 practicing surgeons. Almost all of the operations were performed laparoscopically (99.8%). For combined years 2005-2009, the four most commonly performed procedures were laparoscopic adjustable gastric banding (LAGB, 35.9%), laparoscopic standard Roux-en-Y gastric bypass (LRYGB, 24.3%), laparoscopic sleeve gastrectomy (LSG, 19.5%), and laparoscopic mini gastric bypass (15.4%). Comparing the 5-year trend from 2004 to 2009, the absolute numbers of bariatric surgery procedures in Asia increased from 381 to 2,091, an increase of 5.5 times. LSG increased from 1% to 24.8% and LRYGB from 12% to 27.7%, a relative increase of 24.8 and 2.3 times, whereas LAGB and mini gastric bypass decreased from 44.6% to 35.6% and 41.7% to 6.7%, respectively. The absolute growth rate of bariatric surgery in Asia over the last 5 years was 449%.

Slow progress of bariatric surgery in Thailand: surgeons' opinions.

BACKGROUND: Despite the rapid popularity of bariatric surgery in many countries, this type of surgery has not become very prevalent in Thailand. The purpose of this study was to find out the attitude of Thai general surgeons regarding the advisability of bariatric surgery to obese people. METHODS: Questionnaires were sent to 500 general surgeons asking about their knowledge and opinion regarding the concepts and recommendation of bariatric surgery in their practice. RESULTS: One hundred and sixty-nine surgeons responded to the questionnaires. They were grouped into general surgeons who were not practicing laparoscopic surgery, laparoscopic surgeons who were not doing bariatric surgery and bariatric surgeons. Overall, no more than 50% could give correct answers about the definition of body mass index (BMI) and the mechanism of bariatric surgery. Only about one third and one half of the first two groups of surgeons, respectively, agreed with the recommendation of using surgery to reduce morbid obesity and they gave various reasons, some of which were not based on current and correct knowledge. CONCLUSION: At least half of the Thai surgeons who were not practicing bariatric surgery did not agree with the concept of surgical weight reduction. However, their attitude was not based on sound knowledge and current evidence.

Long-term storage of small surgical instruments in autoclaved packages.

BACKGROUND: In most operating theatres, unused sterile instruments must be re-sterilized according to preset protocols. Protocols differ among institutions and are not based on strong scientific evidence. OBJECTIVE: To determine and compare the duration of sterility of small instruments packaged in double-layered linen versus plastic-paper envelopes after autoclaving. MATERIALS AND METHODS: Two groups of orthopaedic screws were simultaneously sterilized by autoclaving. In Group 1, each screw was packaged in a double-wrapped linen pack. The screws in Group 2 were individually packaged in an inner wrap of paper and an outer plastic-paper envelope that is commercially available. Unwrapped screws in Group 3 served as controls. During the first 48 weeks, five packages were randomly taken from each group, and from 48 weeks to 96 weeks, 20 packages were taken at random and sent for microbial culture. Five screws from Group 3 were also randomly picked with each sample. RESULTS: Up to 96 weeks, no organisms were cultured from any sample from Groups 1 and 2. Almost all samples from Group 3 grew several species of bacteria. CONCLUSION: For small metal instruments, autoclaved packages in double-wrapped linen or double-wrapped plastic-paper combinations can be stored safely for at least 96 weeks.