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Laparoscopic Cholecystectomy (Gallbladder) Hernias- Recurrence Rates (updated Dec 2006)
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Dekalb Surgical Associates has implemented a method of continuous outcomes assessment for a variety of clinical indicators. One of these indicators looks at the long-term survival of patients with breast cancer. Overall five year survival for our patients is over 78%. This data has been compared to published data for Georgia from the National Cancer Data Bank, and is shown below, and includes patients from 1985-1991. Also shown is the 5-year survival for all DeKalb Medical Center patients. |
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Data for patients with Stage II breast cancer from 1997-98 shows similar results for this sub-group. This is the most recent data available for looking at 5-year survival rates. National comparison data for this time period is not yet available, so the national data shown (NCDB, which stands for “National Cancer Data Base”) is from 1995-96. The other comparison is with all other Stage II breast cancer patients treated at Dekalb Medical Center during the 1997-98 time period. The 5-year survival for our patients is 87% compared with 80% for all other patients at DeKalb Medical Center.
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Survival for patients with colon cancer is another important indicator which we monitor. For patients at DeKalb Surgical Associates, the overall 5 year observed survival rate is over 63%. In the past, all patients undergoing surgery for removal of a colon cancer had to go through a bowel cleansing, just like they have for a colonoscopy. But more recent studies have shown that this is often unnecessary. Most patients can be discharged from the hospital within about five days, and sometimes even less. Patients usually are allowed liquids even in the evening following surgery. Laparoscopic techniques are often utilized, depending on the location and size of the cancer. Very few colon cancer patients require a colostomy with current surgical techniques. Low rectal lesions (close to the anus) can be removed through the anus if localized, and cancers higher up can usually be removed through an abdominal incision, re-connecting the colon down very low, close to the anus. The American Cancer Society has set a goal of reducing the incidence of colon cancer by 50% by the year 2015. In order to reach this goal, the routine use of colonoscopy or flexible sigmoidoscopy screening must be fully implemented. Current recommendations are for screening colonoscopy in all patients beginning at age 50, and every 10 years thereafter. For African American patients and in patients with a family history of colon cancer, screening should begin at age 45. Our web site provides more information about colon polyps and cancer under the patient information link. |
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In 2002, the surgeons at DeKalb Surgical Associates performed 169 laparoscopic cholecystectomies. Indications for surgery included: chronic cholecystitis and other chronic conditions in 59%, acute cholecystitis in 28%, and biliary pancreatitis in 13%. The median length of stay was < 1 day. For patients with acute cholecystitis the average length of stay was 3.8 days. Although return to work was not analyzed, most patients return to their usual activities in 5-10 days after an elective procedure.
There were only 2 cases in which the conversion to an open cholecystectomy was necessary, and in both cases this was for severe acute cholecystitis. This represents a conversion percentage of only 1.2%, which compares extremely well with published reports, most of which are in the 5-10% range. There were no cases of common bile duct injury. Intra-operative cholangiography was performed in 30%, on a selective basis. Four percent of patients had common bile duct stones, which were treated either with laparoscopic common bile duct exploration, or with post-operative ERCP.
Not all
patients who are referred with gallstones undergo surgery. Patients with
atypical symptoms undergo further evaluation looking for other pathology,
such as peptic ulcer disease, esophageal reflux, or irritable bowel
syndrome. In patients whose symptoms are correlated with other pathology,
surgery is not recommended unless more typical symptoms develop.
We reviewed all of the breast biopsies performed on our patients for the year 2002. All in all, 445 biopsies were performed, including FNA’s, core biopsies, stereotactic biopsies, and excisional biopsies. There were 82 patients diagnosed with breast cancer, including 11 (13%) with non-invasive disease. One patient had bilateral cancer. The diagnosis was made by needle biopsy in 73 (88%), usually at the first office visit, utilizing ultrasound for localization as needed, thereby allowing for a rapid diagnosis, and subsequent definitive surgical treatment with a single operative procedure.
There were 69 stereotactic biopsies performed, for microcalcifications in 49, and for a nodular or asymmetric density in 20. Cancer was identified in 16 (23%). In 9 of these 16 patients (56%), the cancer was non-invasive.
Of the 82 patients with breast cancer, 7 refused treatment or went elsewhere. Of the remaining 75 patients, 66 (88%) underwent breast-conserving surgery. Compared to published data, this is a remarkably high percentage. In many reported series, particularly in the southeastern United States, conservative surgery rates are typically only about 50%. Sentinel node biopsy was routinely used in all of these patients for clinically node negative disease. Mastectomy was recommended in the other 9 patients because of either a large tumor size, more than one cancer in the breast, strong family history, or involved margins on attempted breast-conserving surgery.
The average tumor size, including those with DCIS
(non-invasive cancer),
was 1.8 cm, with a median size of 1.3 cm. Thirty-seven percent of
patients had tumors less than or equal to 1 cm in size.
In summary, prompt and
accurate evaluation of breast problems constitutes a major focus for
DeKalb Surgical Associates. We are committed to providing a timely and
cost-effective diagnosis, with a high priority for
breast conservation and sentinel node biopsy for patients diagnosed with
cancer.
Hernia Repair- Recurrence Rate (updated Dec 2006)
DeKalb Surgical Associates routinely follows up patients who have previously undergone inguinal hernia repairs to monitor for recurrence. Below are summaries of these questionnaires, with the most recent summary listed first. If you just want the final result, our cumulative recurrence risk for all hernia repairs is 1%.
In early 2006, we once again sent out a questionnaire to our hernia patients from 2 years ago. Of the entire group, there was 1 confirmed hernia out of 176 repairs (0.57%). Of those who responded, the confirmed hernia recurrence rate is 1.01% (1/99).
Compared to the previous follow-ups conducted in November 2001, and July 2002, response rate was similar, though slightly lower. The percentage of patients responding was 53%. The response rate for the last two surveys was 59% and 63%, respectively. This survey was conducted several months later for the entire group as an average, compared to previous surveys, and this is the probable explanation for the lower response rate.
If the results of the three surveys are combined, there are 5 confirmed recurrences out of a total of 494 repairs, for a rate of 1.01%, and a rate of 1.74% (5/187) for only those who responded. Two of the five confirmed recurrences were done laparoscopically.
If only the non-laparoscopic repairs are considered, the recurrence rate for the three combined surveys is 0.68% (3/443), and 1.23% (3/243) of only those who responded. If only the laparoscopic repairs are considered, the corresponding recurrence rates for the three combined surveys are 6.9% (2/29) and 11.1% (2/18).
Patients who had hernia repairs between 18 and 36 months ago were contacted by mail or telephone in the fall of 2003. Followup rate was 59%.
There were 159 patients with a total of 180 hernia repairs (21 with bilateral repairs) performed between October 1, 2000, and March 31, 2002. There were 3 recurrences identified for a recurrence rate of 1.7%. This recurrence rate compares very favorably with published recurrence rates. If results are combined with our previous 2 year survey, the overall recurrence rate is 4/318, or 1.3%.
We have previously identified a slightly higher recurrence rate among patients undergoing a laparoscopic repair. One of the three patients with recurrence in this group had a laparoscopic repair. Both repair methods are offered to our patients, "traditional" or laparoscopic, although the majority of patients undergo an open repair. Most often, this is done as an outpatient, under local anesthesia with sedation. The laparoscopic repair is also done as an outpatient, but under general anesthesia. Time out of work is variable, depending on the type of work done, and employer expectations, and your own individual response to the surgery. For non-strenuous (desk-type) jobs, many patients will be back at work work within three to seven days. For very heavy labor (construction-type), the time off work may be up to four weeks or more.