|
AUDIT
DATA
Outcomes
of surgery will be updated next January, 2006
LAPAROSCOPIC
ANTI-REFLUX SURGERY
| |
Number |
Conversions
(%) |
Mean
stay (days) |
Reoperations |
Endoscopic
dilatations |
Complications |
| 1993-1997 |
133 |
13
(10%) |
2 |
13
(10%) |
23
(17%) |
|
| 1998-2002 |
288 |
3
(1%) |
2 |
5
(1.7%) |
7
(2.4%) |
|
| 2003 |
78 |
0
(0%) |
1 |
- |
0
(0%) |
2
chest infection
1 pulmonary embolus
1 wrap perforation
1 urinary retention |
| 2004 |
96 |
1
(1%) |
1 |
- |
2
(2%) |
1
wrap perforation
1 splenectomy
2 urinary retention |
Landmark
papers
Booth MI, Stratford J, Jones L., Dehn TCB. Results of laparoscopic
Nissen fundoplication at 2 to 8 years after surgery. British Journal
of Surgery 2002; 89:476-481. This study of 179 patients undergoing
keyhole anti-reflux surgery shows the patient satisfaction rate
was 91% at a median follow-up at 48 (24-99) months. 90% of patients
were free of reflux symptoms - 22% experience some side effects
- mainly increase in wind - but this rarely affects the patient
satisfaction.
Lafullarde
T, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG. Laparoscopic
Nissen fundoplication 5 years results and beyond. Archives of Surgery
2001;136(2);180-4. Five year outcome analysis of 178 patients undergoing
laparoscopic anti-reflux surgery at the Royal Adelaide Hospital,
Australia. Data available for 166 patients: 87% were free of significant
reflux symptoms 5-8 years post-operatively. Re-operation was necessary
for: - recurrent reflux 3 (1.7%), difficulty in swallowing 7 (3.9%)
and para oesophageal hernia 13 (7.3%).
Bammer
T, Hinder ERRA, Klaus A et al. 5-8 year outcome of the first laparoscopic
Nissen fundoplications. J.Gastrointestinal Surgery 2001;5:42-8
Postal questionnaire follow up of 171 patients who had undergone
laparoscopic anti-reflux surgery at the Mayo Clinic, USA. Overall
96.5% were satisfied with the results. 27% of patients reported
difficulty with swallowing, 70 % required a dilatation.
Booth MI, Statford J, Thomspon E, Dehn, TCB. Laparoscopic anti-reflux
surgery in the treatment of the acid sensitive oesophagus. British
Journal of Surgery 2001;88:577-582. Results of keyhole antireflux
surgery in specific conditions of acid sensitive oesophagus
LAPAROSCOPIC
CHOLECYSTECTOMY
| |
Number |
Conversion
to open operation |
Mean
stay (days) |
Daycases
(% total) |
Complications |
| 1991-96 |
500
approx |
Analysis
unavailable due to computer loss |
- |
- |
|
| 1997-2002 |
917 |
46
(5.0%) |
- |
- |
16
bile leaks (1.7%)
2 bile duct injuries (1 death)
|
| 2003
|
293 |
11
(3.7%) |
1 |
86
(29%) |
2
bile leaks (0.7%)
1 bile duct injury
(repaired at time)
1 urinary retention
1 subphrenic collection
|
| 2004 |
297 |
6
(2.0%) |
1 |
97
(33%) |
5
bile leaks (1.7%)
3 urinary retention
1 subphrenic abscess
1 myocardial infarct |
Bile
duct injury rate 3/1607 = 0.78% (i.e. 1 in 500)
Landmark
papers
Leeder PC, Matthew T, Krzeminska K, Dehn TCB. Day case laparoscopic
cholecystectomy - a standardised technique ensures a high rate of
patient satisfaction and low readmission. British Journal of Surgery.
A study of 357 patients undergoing laparoscopic cholecystectomy
over 2 years. 148 (43%) underwent elective daycase surgery - 22
(14%) required overnight stay. 92% of patients were very satisfied
with daycase surgery. This paper illustrates how a dedicated day
case team can reduce cost whilst maintaining a high rate of patient
satisfaction.
LAPAROSCOPIC
INGUINAL HERNIA SURGERY
| |
Number
of patients |
Number
of repairs |
Conversion
to open operation |
Recurrences |
Complications |
| 1994
–96 |
80
approx |
Analysis
lost due to computer loss |
|
|
|
| 1997-
2002 |
261 |
365;
(45 bilateral repairs; 20 repairs of recurrent hernias) |
2
(0.7%); adhesions 1, abnormal anatomy 1 |
4
(1%) |
5
cord haematoma
6
urinary retention
4
port site infections
3
hydrocoele
3
lateral cutaneous nerve injury (temporary)
1
groin pain <12 wk
1
reoperation (to exclude recurrence)
|
|
2003 |
79 |
105
(26 bilateral; 10 repairs of recurrent hernias) |
2
(1.9%); adhesions |
- |
3
cord haematoma
1
urinary retention
|
| 2004 |
144 |
184 |
1
(0.5%) |
2
(1%) |
1
urinary retention
1 cord haematoma |
Landmark
papers
Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM. Prospective
randomised controlled trial of laparoscopic versus open inguinal
hernia mesh repair: five year follow up. British Medical Journal
2003; 325:1012-3. A 5 year follow up of a randomised trial comparing
outcome of 122 patients undergoing keyhole groin hernia surgery
against 120 patients undergoing "traditional" open mesh
hernia repair.
| Complications |
Keyhole
Surgery (TAPP) |
Traditional
surgery |
| No
with complications |
13
(11%) |
52 (43%) |
| Numbness |
3
(3%) |
27
(23%) |
| Groin
pain |
2
(2%) |
12
(10%) |
| Testicular
pain |
4
(3%) |
6
(5%) |
| Recurrent
hernia |
2
(2%) |
3
(3%) |
Kumar
S, Wilson RG, Nixon SJ et al. British Journal of Surgery 2002;89:1476-9.
This study compared chronic groin pain in 240 patients undergoing
another form of keyhole groin hernia surgery (TEPP) against 214
patients with open mesh repair.
| |
Keyhole
(TEPP) |
Open
Mesh |
| Chronic
groin pain |
10
(4.2%) |
24
(11.2%) |
Bittner
R, Schmett C-E, Schwartz ARZJ et al. Laparoscopic transperitoneal
(TAPP) procedure for routine repair of groin hernia. BrJSurg 2002;89:1062-6.
An important paper from Stuttgart reviewing results of 8050 TAPP
keyhole groin hernia repairs. Overall complication rate was 3.2%
over a nine year study period. Recurrent hernia rate following TAPP
repair dropped from 4.8% to 0.4%. Median time return to work was
15 (2-100) days: 14 days after 1 sided primary repair, 21 days after
recurrent hernia repair and 15 days after bilateral primary repair.
LAPAROSCOPIC
ACHALASIA SURGERY
| |
Number |
Conversion
to open operation |
Mean
stay (days) |
Median
stay (days) |
Complications |
Revision
Surgery
|
| 1995-2003 |
24 |
0 |
2.4 |
2 |
2
deaths (*unusual cases – more details
available on request) |
2 |
LAPAROSCOPIC
ROLLING HIATUS HERNIA SURGERY
|
Number |
Conversion
to open operation |
Median
stay ( days) |
Complications |
| 1995-2004 |
73 |
5
(7%) |
2 |
2
early recurrences (1 gastric necrosis)
2 urinary retention
|
Leeder
P, Smith G, Dehn TCB Laparoscopic management of giant paraoesophageal
hiatus hernia. Surg Endosc 2003 ;17:1372-1375
OESOPHAGEAL
CANCER
| |
Number
seen |
Numbers
operated |
Technique |
Complications |
In-hospital
mortality |
ITU
stay/days, mean (range) |
Hospital
stay/days, mean (range) |
| 1996-2001 |
232 |
81
(35%) |
27
Ivor Lewis,
30
Left thoraco-abdominal,
8
trans hiatal,
5
three-stage,
7
thoracoscopic three-stage,
4
laparoscopic Ivor Lewis
|
9
anastomotic leaks (5 clinical, 4 radiological),
4
thoracic duct leaks,
10
respiratory,
4
splenectomy,
5
recurrent laryngeal nerve injuries (temporary),
4
cardiac
|
1
(1.2%) |
2.9
(1-22) |
14.7
(9-92) |
| 2002 |
56 |
12
(21%) |
8
Thoracoscopic 3-stage (1 conversion)
2
trans-hiatal
2
open
|
2
thoracic duct leak - 1 repaired
1 myocardial infarct
1 colonic necrosis - revision surgery
1 leak - resolved
1 tracheal injury (minor))
|
1 |
3
(1-10) |
18.3
(11-30) |
| 2003 |
57 |
13
(23%) |
6
thoracoscopic 3-stage
3 left thoraco-abdominal
2 Ivor Lewis
1 thoracoscopic Ivor Lewis
1 laparoscopically assisted trans-hiatal
|
2
splenectomy
1 respiratory failure
1 laryngeal nerve palsy
|
1 |
2.4
(1-9) |
13
(10-21) |
| 2004 |
50 |
17 |
10
minimally invasive
3-stage
2 thoracoscopic 3-stage
1 laparoscopic Ivor Lewis
1 open 3-stage
3 left thoraco-abdominal
|
1
gastric necrosis
2 cervical leaks
|
0
|
2.4
(1-16) |
16
(10-45) |
GASTRIC
CANCER
| |
Number
seen |
Number
operated |
Operation |
Complications |
In
hospital mortality |
Hospital
stay/days,
mean (range) |
| 1992-2001 |
97 |
39
(40%) |
26
subtotal gastrectomy
13 total gastrectomy
|
2
anastomotic leaks
2 post-operative bleeds
2 respiratory
1 pancreatic fistula
1 cardiac
|
1 |
13.3
(7-30) |
| 2002 |
26 |
7
(27%) |
3
subtotal gastretcomy
3 total gastrectomy
1 proximal gastrectomy
|
1
wound infection |
1 |
9.6
(7-14) |
| 2003 |
25 |
7
(28%) |
3
subtotal gastrectomy
2 total gastrectomy
1 thoraco-abdominal oesophago-gastrectomy
1 laparoscopically assisted partial gastrectomy |
2
myocardial infarction
1 duodenal stump leak (late) |
1 |
10
(8-30) |
| 2004 |
21 |
3
(14%) |
2
total gastrectomy
1 subtotal gastrectomy
|
1
prolonged vomiting |
0 |
18
(8-35) |
|
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