Respiratory Physiology in Upper Abdominal Surgery

Ford, Gordon; Rosenal, Thomas W.; Clergue, F.; Whitelaw, William A.

doi:10.1016/s0272-5231(21)00888-1

Cited by 96 publications

(3 citation statements)

References 61 publications

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“…The tumor characteristics highlight a more advanced disease in this group, and surgery was more difficult, as suggested by a longer operative time and a higher adjacent organ resection rate. However, the right or bilateral transection of the abdominal muscles and prolonged retraction of the right hemidiaphragm reduce vital capacity and functional residual capacity, and increase the risk of postoperative pulmonary complications that occurred more frequently in this group [4, 21]. Indeed, short‐term postoperative benefits of laparoscopic approach (i.e., preservation of abdominal wall, reduction of postoperative pulmonary complications [4], and improvement in early postoperative rehabilitation [22]) are probably jeopardized in patients who underwent subcostal incision to remove the specimen [18, 23].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

et al. 2019

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Background In laparoscopic major hepatectomy, analysis of outcomes according to specimen extraction site remains poorly described. The aim was to compare postoperative outcomes according to specimen extraction site. Methods From 2000 to 2017, all laparoscopic major hepatectomies were reviewed and postoperative outcomes were analyzed according to specimen extraction site: subcostal (Group 1), midline (Group 2), or suprapubic (Group 3) incision. Results Among 163 patients, 15 (9.2%) belonged to Group 1, 49 (30.1%) in Group 2, and 99 (60.7%) in Group 3. The proportion of right-sided, left-sided, or central hepatectomies, mortality, and overall and severe complications were comparable between groups. Group 1 had larger tumors (61 vs. 38 vs. 47 mm; P = 0.014), higher operative time (338 vs. 282 vs. 260 min; P \ 0.008), higher adjacent organ resection rate (46.6 vs. 16.3 vs. 7.1%; P \ 0.001), and tended to increase pulmonary complications (40.0 vs. 12.2 vs. 18.2%; P = 0.064). In Group 2, a previous midline incision scar was more frequently used for specimen extraction site (65.3 vs. 26.6 and 30.3%, Group 1 and 3; P \ 0.001). Postoperative incisional hernia was observed in 16.4% (n = 23) and was more frequent in Group 2 (26.6 vs. 6.6% and 10.1%, Group 1 and Group 3; P = 0.030). Finally, Group 2 (HR 2.63, 95% CI 1.41-3.53; P = 0.032) was the only independent predictive factor of postoperative incisional hernia. Conclusions While using a previous incision makes sense, the increased risk of postoperative incisional hernia after midline incision promotes the suprapubic incision.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

et al. 2019

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“…The discussion of our study reveals critical insights into the pulmonary complications following liver transplantation, a topic that has been sporadically addressed in previous literature (2,13,14). Notably, pneumonia has emerged as a significant life-threatening postoperative complication (15,16).…”

Section: Discussionmentioning

confidence: 79%

Frequency of Chest Complications after Liver Transplantation

Hassan,

Murtaza,

Haider

et al. 2024

JHRR

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Background: Liver transplantation is a critical intervention for patients with advanced liver disease. However, postoperative complications, particularly pulmonary complications, significantly impact patient outcomes. Understanding these complications is essential for improving post-transplant care. Objective: To investigate the prevalence and nature of pulmonary complications in liver transplant recipients and to identify potential risk factors associated with these complications. Methods: This study was conducted at the Hepatobiliary and Liver Transplant Centre, Shaikh Zayed Hospital, Lahore, Pakistan, over a six-month period. A case series design with non-probability purposive sampling was employed. The sample size, determined using the WHO Sample Size Tool, was set at 100 participants, given logistical constraints. Data collection involved detailed postoperative assessments to identify pulmonary complications. The study included participants of all sexes and ages awaiting liver transplantation, excluding those undergoing a second transplant. Data analysis was performed using SPSS version 25. Results: Out of 100 liver transplant recipients, 98.5% (n=128) presented with stable vital signs at the time of data collection, while 1.5% (n=2) were unstable. Discharge planning indicated 68.5% (n=89) under observation and 23.1% (n=30) with routine planning. In terms of education, 59.2% (n=77) had 10 years of education, and 16.9% (n=22) were illiterate. Donor health status was excellent in 98.5% (n=128) of cases. Pulmonary complications included respiratory infections (23.8%, n=31), pleural effusion (36.2%, n=47), atelectasis (15.4%, n=20), bronchospasm (7.7%, n=10), and pneumonia (9.2%, n=12). Conclusion: The study highlights a significant incidence of pulmonary complications post-liver transplantation, with pleural effusion, respiratory infections, and atelectasis being the most common. These findings underscore the need for enhanced monitoring and proactive management of pulmonary complications in liver transplant recipients.

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“…The traditional open liver resection may increase the risk of cardiopulmonary complications through several mechanisms, such as painful limitation of the thoracic cage, resulting in a 50-60% reduction of the vital capacity and a 30% reduction in functional residual capacity [19]. HALS is less traumatic to the abdominal wall and typically results in decreased postoperative pain and early postoperative rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Short- and Long-Term Outcomes in Elderly Patients Following Hand-Assisted Laparoscopic Surgery for Colorectal Liver Metastasis

Mahamid

Abu-Zaydeh

Mattar

et al. 2023

JCM

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(1) Background: Hand-assisted laparoscopic surgery (HALS) has engendered growing attention as a safe procedure for the resection of metastatic liver disease. However, there is little data available regarding the outcomes of HALS for colorectal liver metastasis (CRLM) in patients over the age of 75. (2) Methods: We compare the short- and long-term outcomes of patients >75-years-old (defined in our study as “elderly patients” and referred to as group 1, G1), with patients <75-years-old (defined in our study as “younger patients” and referred to as group 2, G2). (3) Results: Of 145 patients, 28 were in G1 and 117 were in G2. The most common site of the primary tumor was the right colon in G1, and the left colon in G2 (p = 0.05). More patients in G1 underwent laparoscopic anterior segment resection compared with G2 (43% vs. 39% respectively) (p = 0.003). 53% of patients in G1 and 74% of patients in G2 completed neoadjuvant therapy (p = 0.04). The median size of the largest metastasis was 32 (IQR 19–52) mm in G1 and 20 (IQR 13–35) mm in G2 (p = 0.001). The rate of complications (Dindo-Clavien grade ≥ III) was slightly higher in G1 (p = 0.06). The overall 5-year survival was 30% in G1 and 52% in G2 (p = 0.12). (4) Conclusions: Hand-assisted laparoscopic surgery for colorectal liver metastasis is safe and effective in an elderly patient population.

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Respiratory Physiology in Upper Abdominal Surgery

Cited by 96 publications

References 61 publications

Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

Frequency of Chest Complications after Liver Transplantation

Short- and Long-Term Outcomes in Elderly Patients Following Hand-Assisted Laparoscopic Surgery for Colorectal Liver Metastasis

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