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Li Luo,1 Jiduan Jiang,2 Min Zhang,1 Zhiqiang Guo,1 Xianzheng Zhang,1 Fenglin Wang,1 Fan Yang1 1Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, People’s Republic of China; 2Department of Anesthesiology, Suining First People’s Hospital, Suining City, Sichuan Province, People’s Republic of ChinaCorrespondence: Fan Yang, Department of Anesthesiology, Suining Central Hospital, Suining City, Sichuan Province, 629000, People’s Republic of China, Email yanglifan2@163.comObjective: To study the efficacy and safety of different doses of remimazolam used for induction and maintenance in short laparoscopic surgery.Methods: A randomized controlled trial was conducted between May 2021 and May 2022 on patients underwent laparoscopic surgery for 30 minutes to an hour. Based on the drug used and the infusion rate, included patients were allocated into the Low-group of remimazolam (using a constant infusion rate of 6.0 mg/kg/h for induction and the rate of 1 mg/kg/h for maintenance), the Median-group (9.0 mg/kg/h for induction, 2 mg/kg/h for maintenance), the High-group (12.0 mg/kg/h for induction, 3.0 mg/kg/h for maintenance), and the Propofol group. The postoperative extubation time was used as the primary outcome.Results: A total of 192 patients were included in the study, with 47, 48, 48, and 49 patients in the Low-, Median-, High-, and Propofol group, respectively. There was a significant difference in postoperative extubation time, with the High-group having the highest duration of 15.21± 2.34 minutes compared to the Median-group (13.17± 1.71 minutes, p< 0.001), Low- group (12.72± 1.31 minutes, p< 0.001), and the Propofol group (12.24± 1.23 minutes, p< 0.001). No significant difference was found between the Low-group and the Propofol group, while the Median-group still showed higher postoperative extubation time compared to the Propofol group (p=0.008).Conclusion: Compared to propofol, total intravenous induction and maintenance with high and median dosages of remimazolam may prolong postoperative extubation time. Remimazolam can be safely used for induction and maintenance at various doses while not increasing the likelihood of adverse events.Keywords: remimazolam, propofol, general anesthesia, extubation time, laparoscopic surgery

Background: mechanical bowel preparation (MBP) is a common practice before laparoscopic gynecologic surgeries but the role and efficacy of preparation have been questioned. this study assesses visualization and bowel handling in a group of patients who receive MBP and the control group and thereafter; compares the results. Methods: We designed and conducted this randomized, single-blinded and controlled trial on patients who underwent advanced gynecologic laparoscopic surgeries. This clinical trial was carried out between July 2020 and January 2021. The patients were enrolled from l the laparoscopic office. 120 women aged 18-65 years undergoing level 2 and 3 benign gynecologic laparoscopic surgeries were randomized to bowel preparation with a normal saline enema (n=60) or non-bowel preparation (n=60) groups. Our patients underwent level 2 and 3 of benign laparoscopic gynecologic surgeries with or without MBP. The visualization and bowel handling were assessed by the primary surgical team and a questionnaire was later obtained. The outcomes included intraoperative surgical view and bowel handling, preoperative and post-operative patient signs and symptoms. The patients were also assessed in respect to discomfort prior and after the surgery, this assessment was obtained using a questionnaire. The gathered data was analyzed using IBM’s SPSS v26 software. Results: there was no difference in intraoperative visualization and bowel handling between the two groups. We also found no clinical improvements in respect to discomfort and symptoms. MBP even increased the distention rate amongst patients (P-value=0/04). We tried to evaluate whether MBP had any effects on haemorrhage and blood loss during the surgery and to assess this we compared hemoglobin levels before and after the surgery. We compared the subtracted values between the two groups and found no significant difference (T-test=1.135, P=0/259) (see table 4). However, hospitalization duration was about 5 hours longer in the group who received MBP. Conclusion: MBP with normal saline enema does not improve intraoperative visualization and bowel handling. And it also does not reduce patient complication rates and post-operative symptoms either. MBP also increases hospitalization duration and puts extra pressure on the healthcare system. Therefore, a normal saline enema is not recommended before benign gynecologic laparoscopic surgeries.

INTRODUCTION[|]To compare of the histopathological and oncological outcomes of patients undergoing laparoscopic or open resection surgery for sigmoid colon cancer.[¤]METHODS[|]All of the patients who underwent surgical resection for sigmoid colon cancer between July 2014 and December 2016 were included in this study. The demographic characteristics, T/N staging, number of benign/malignant lymph nodes, histopathological findings, follow-up period, overall survival, and disease-free survival (DFS) of both groups were evaluated.[¤]RESULTS[|]A total of 43 patients were evaluated in this study. The female to male ratio was 14/29. The mean age of the patients was 64.11+-11.75 years. The median number of dissected lymph nodes was 20.9 (10–31) in the open resection group and 19.46 (7–36) in the laparoscopic group (p=0.539). The overall 3-year survival was 87% in the open resection group and 85% in the laparoscopic group (p=0.62). The 3-year DFS rate was 79% in the open surgery group and 75% in the laparoscopic group (p=0.70).[¤]DISCUSSION AND CONCLUSION[|]Laparoscopic and open surgery for sigmoid colon cancer provide equivalent oncological results; laparoscopic surgery can be performed safely in these patients. When the laparoscopic surgery technique is standardized and efforts are made to improve training, laparoscopic surgery will likely become standard treatment for colon cancer.[¤]

Background:For endoscopic visualization of the peritoneal cavity, pneumoperitoneum has to be created. This study was conducted to compare the mean time consumption for creation of pneumoperitonium from open (transumblical) and closed (Veress needle) method in laproscopic surgery. Material & Methods: It was a cross sectional study conducted at Department of Surgery, Gomal Medical College, D.I.Khan, from March 1, 2014 to August 30, 2014. One hundred and thirty patients were selected using consecutive sampling. The patients enrolled in the study were admitted patients of both genders requiring laparoscopic surgery. Females with third trimester pregnancy, and patients with midline laparotomy scar were excluded. Informed consent was taken from every patient before surgery. They were divided in two equal groups selected using random number table; Group A= Closed (VN) and Group B= Open (Transumblical). Time for the creation of pneumoperitoneum was calculated. It started from the incision until creation of 14 mmHg intra-abdominal pressure. Qualitative variables like gender, diagnosis, complications were presented as percentages. Continuous variables like age and time for creating pneumoperitoneum were presented as Mean ± Standard Deviation. Data was analyzed using SPSS version 10. The significance of difference between time taken by either procedure was measured by Independent sample ‘t’ test. P ≤0.05 was taken as significant. Results: Time required to insert laparoscope was significantly different in both groups; 125.56±6.2 seconds for Veress needle group and 90.6±2.02 seconds for open (transublical) group. Conclusion: Open (transumbilical) method of creation of pneumoperitoneum is much less time consuming than closed (Veress Needle) technique.

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To describe a newly created all-Nordic cohort of patients with gastro-oesophageal reflux disease (GORD), entitled the Nordic Antireflux Surgery Cohort (NordASCo), which will be used to compare participants having undergone antireflux surgery with those who have not regarding risk of cancers, other diseases and mortality., Participants: Included were individuals with a GORD diagnosis recorded in any of the nationwide patient registries in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) in 1964-2014 (with various start and end years in different countries). Data regarding cancer, other diseases and mortality were retrieved from the nationwide registries for cancer, patients and causes of death, respectively., Findings to Date: The NordASCo includes 945 153 individuals with a diagnosis of GORD. Of these, 48 433 (5.1%) have undergone primary antireflux surgery. Median age at primary antireflux surgery ranged from 47 to 52 years in the different countries. The coding practices of GORD seem to have differed between the Nordic countries., Future Plans: The NordASCo will initially be used to analyse the risk of developing known or potential GORD-related cancers, that is, tumours of the oesophagus, stomach, larynx, pharynx and lung, and to evaluate the mortality in the short-term and long-term perspectives. Additionally, the cohort will be used to evaluate the risk of non-malignant respiratory conditions that might be caused by aspiration of gastric contents., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)