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Patient reported outcomes in elective laparoscopic cholecystectomy
Malcolm H.W. Mak,Woon Ling Chew,Sameer P. Junnarkar,Winston W.L. Woon,Jee-Keem Low,Terence C.W. Huey,Vishalkumar G. Shelat 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.1
Backgrounds/Aims: Traditional outcome measures (e.g., length of hospital stay, morbidity, and mortality) are used to determine the quality of care, but these may not be most important to patients. It is unclear which outcomes matter to patients undergoing elective laparoscopic cholecystectomy (ELC). We aim to identify patient-reported outcome measures (PROM) which patients undergoing ELC valued most. Methods: A 45-item questionnaire with Four-point Likert-type questions developed from prior literature review, prospectively administered to patients treated with ELC at a tertiary institution in Singapore. Results: Seventy-five patients participated. Most essential factors were technical skill and experience level of a surgeon, long-term quality of life (QoL), patient involvement in decision-making, communication skill of a surgeon, cleanliness of the ward environment, and standards of nursing care. Least important factors were hospitalization leave duration, length of hospital stay, a family’s opinion of the hospital, and scar cosmesis. Employed patients were more likely to find hospitalization leave duration (p<0.001) and procedure duration (p=0.042) important. Younger patients (p=0.048) and female gender (p=0.003) were more likely to perceive scar cosmesis as important. Conclusions: Patients undergoing ELC value long-term QoL, surgeon technical skill and experience level, patient involvement in decision-making, surgeon communication skill, cleanliness of the ward environment, and nursing care standards. Day-case surgery, medical leave, family opinion of hospital, and scar cosmesis were least important. Understanding what patients value will help guide patient-centric healthcare delivery.
Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula
Tang Ee Ling Serene,Shelat Vishalkumar G,Junnarkar Sameer Padmakumar,Huey Cheong Wei Terence,Low Jee Keem,Wang Bei,Woon Wei Liang Winston 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.4
Backgrounds/Aims: Traditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days’ (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF). Methods: We conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used. Results: 5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93-1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low. Conclusions: Patients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.
Laparoscopic splenectomy for splenic rupture secondary to metastatic choriocarcinoma
Tan Ming Ngan Aloysius,Vishalkumar G Shelat 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.1
Gestational choriocarcinoma is a rare and aggressive type of gestational trophoblastic neoplasia, which is characterized by early vascular invasion and widespread metastases. Choriocarcinoma metastasizes hematogenously, and bleeding from metastases is common. Splenic rupture from a metastatic tumour is exceedingly rare, with only a few reports. We report a case of a 41-year-old female presenting with acute abdomen and haemorrhagic shock secondary to splenic rupture from metastatic choriocarcinoma, which was managed with emergency laparoscopic splenectomy.
Inferior vena cava leiomyosarcoma in an octogenerian
Sudharsan Madhavan,Sameer P Junnarkar,Nicholas Wee Chong Koh,Vishalkumar G Shelat 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.3
Inferior Vena Cava (IVC) leiomyosarcoma (LM) is a rare malignancy of mesenchymal origin with an incidence of 1/100,000. We present an 82-year-old lady with a past history of open cholecystectomy who presented with a large indeterminate mass on abdominal imaging. Open resection of the mass was performed and histology with immunohistochemical staining revealed leiomyosarcoma. She received adjuvant radiotherapy and remained disease free 4 years after.