Laproscopy procedure has become the gold standard for For high-risk patients undergoing Holmium laser enucleation of the prostate (HoLEP), spinal anesthesia (SpA) affords a safe and efficient alternative to general anesthesia (GA).
Patients managed for lower urinary tract symptoms with HoLEP (n=300) in SpA with ASA>2 (n=100), GA with ASA>2 (GA-high-risk) (n=100) or GA with ASA≤2 (GA-low-risk) (n=100) were included.
Propensity-score-matching was applied.
SpA offered a comparable functional outcome to GA.
SpA provided greater hemodynamic stability, faster overall postoperative recovery with preferable pain management. organ systems, with some of the most common being reproductive (particularly gynecological) and digestive (as for cholecystectomy). Significant improvements in surgical training, as well as developments of instruments, imaging, and surgical techniques, have made laparoscopic surgery safe and feasible across different medical fields.
Laparoscopy is superior to open surgery for elective colectomy, but its role in emergency colectomy remains unclear. Previous studies were small and limited by confounding because surgeons may have selected lower-risk patients for laparoscopy.
Laparoscopic surgery for colorectal emergencies appears to improve outcomes compared with open surgery, suggests a recent study published in the Surgery Journal.
George C. Linderman and associates from the Department of Surgery, Yale School of Medicine, New Haven, CT therefore studied the effect of attempting laparoscopy for emergency colectomies while adjusting for confounding using multiple techniques in a large, nationwide registry.
During the span of four years, the authors identified emergency colectomy cases. The researchers first compared outcomes between patients who underwent laparoscopic versus open surgery, while adjusting for baseline variables using both propensity scores and regression.
Next, a negative control exposure analysis was performed. By assuming that the group that converted to open did not benefit from the attempt at laparoscopy, they used the observed benefit to bound the effect of unmeasured confounding.
The research showed that of 21,453 patients meeting criteria, 3,867 underwent laparoscopy, of which 1,375 converted to open. In both inverse probability of treatment weighting and regression analyses, attempting laparoscopy was associated with improved 30-day mortality, overall morbidity, anastomotic leak, surgical site infection, postoperative septic shock, and length of hospital stay compared with open surgery. These effects were consistent with the lower bounds computed from the converted group.
Hence, the authors concluded that "laparoscopic surgery for colorectal emergencies appears to improve outcomes compared with open surgery."
The benefit is observed even after adjusting for both measured and unmeasured confounding using multiple statistical approaches, thus suggesting a benefit not attributable to patient selection, they further added.
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https://doi.org/10.1016/j.surg.2021.06.048