7th Postoperative Day Research Articles

Benign hepatic tumors in childhood: surgical resection and outcomes

BackgroundPrimary hepatic neoplasms in pediatric age are rare entities. Clinical and survival data in children with benign liver tumors who were treated by surgery are still negligible. We aimed to present a tertiary oncological center experience regarding surgical management and outcomes of pediatric benign hepatic tumors.Material and methodsA retrospective chart review was performed including all children with benign liver tumors who were surgically managed at our institution from January 2014 to January 2022. Patients’ demographics, presentations, imaging scans, pathological subtypes, operative details, complications that happened, and overall outcomes were discussed.ResultsOne-hundred ninety-three children with liver tumors were referred to our center, and 28 of them had benign tumors (14.5%). Ten patients were managed by medical therapy (all were IHH/hemangiomas), and the remaining 18 were treated by surgery. Of the 18 patients; there were 10 females (55.5%), and the median age at diagnosis was 24 months (range: 5–108 months). Palpable abdominal mass was the main symptom in 14 patients (77.8%). Eleven patients (61%) were PRETEXT II, while the remaining 7 (39%) were PRETEXT I. The median tumor size was 10.9 cm (range: 7.2–18 cm). Preoperative biopsy was conducted in 12 patients (66.7%). Seventeen patients had primary resection, while the remaining child with IHH/hemangioma underwent delayed surgery. Twelve cases had segmental resection or sectionectomy, and hemihepatectomy was performed in the remaining six. The resection rate of benign tumors versus all liver resections at our center during the study period was 12% (18/151). There were no intraoperative complications encountered in any patient. Only one patient developed biliary leakage on the 5th postoperative day which was managed conservatively. At a median follow-up time of 40 months, there were no deaths or recurrences among the included patients.ConclusionsSurgical resection is the principal modality of management for the majority of pediatric benign liver tumors, which constituted 12% of our hepatic resection rate. Complete excision with negative margins can be performed without significant morbidity for such tumors, and it achieves excellent clinical and long-term oncological outcomes.

Effect of Bioabsorbable Poly (dl-Lactide ε-Caprolactone) on Healing of Experimentally Injured Acute Traumatic Middle Ear Mucosa Damage.

Postoperative adhesion is an important complication after middle-ear surgeries. Although many materials have been tried to prevent this complication, the use of Poly (dl-lactide ε-caprolactone) as an anti-adhesive material after middle-ear surgery has not yet been reported. The aim of this study was to evaluate the anti-adhesive effect of poly (dl-lactide ε-caprolactone) on the ears of rats with middle-ear mucosa damage. In our study, 14 Wistar albino rats and 28 ears in total were used. The rats were randomly divided into 4 groups. Middle ear mucosa damage was performed in all groups with a transcanal approach under otomicroscopy in sterile conditions. The effects of poly (dl-lactide ε-caprolactone), silicone sheet, and absorbable gelatin sponge were compared histologically with the secondary healing group. In addition, hearing evaluation was performed before the procedure and on the 28th postoperative day. No significant difference was observed in transient otoacoustic emission and distortion product otoacoustic emissions tests performed before and after the surgical procedure when the groups were compared. While adhesion was observed in the tympanic membrane in the absorbable gelatin sponge group, no adhesion was observed in the other groups. In the absorbable gelatin sponge group, increased fibroblastic activity, inflammation, and neovascularization were observed in the middle-ear mucosa. No significant difference was observed in silicone sheet, poly (dl-lactide ε-caprolactone), and control groups in terms of fibroblastic activity, inflammation, and neovascularization. It can be concluded that absorbable poly (dl-lactide ε-caprolactone) is nonototoxic and biocompatible with the rat's middle ear cavity by short-term evaluation.

Right axillopopliteal artery bypass using a combined transiliac and lateral popliteal approach for groin infection and lymph fistula.

Wound infection in the groin is a serious complication after vascular bypass surgery. The combined treatment of critical limb ischemia and recurrent infection presents challenges for vascular surgery(1Lounes Y. Ozdemir B. Alric P. Canaud L. Trans-iliac Bypass for Critical Limb Ischaemia with Groin Necrosis: A Case Report.EJVES Short Reports. 2019; 42: 31-33https://doi.org/10.1016/j.ejvssr.2019.01.002Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 2Multon S. Jayet J. Javerliat I. Coscas R. Coggia M. Aortic–tibial transiliac wing extra-anatomic bypass with distal fistula for treatment of an infected deep femoral pseudoaneurysm.J Vasc Surg Cases, Innov Tech. 2022; 8: 201https://doi.org/10.1016/j.jvscit.2022.02.008Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 3Engin C, Posacioglu H, Ayik F, Apaydin A . Management of vascular infection in the groin. Texas Hear Inst J (2005) 32:529–534.Google Scholar). In this case, we successfully managed the wound infection in the groin after axillofemoral artery bypass grafting, using a combination of trans-iliac bypass and lateral popliteal approach(4Enzmann F.K. Nierlich P. Eder S. Aspalter M. Dabernig W. Aschacher T. et al.Trans-Iliac Bypass Grafting for Vascular Groin Complications.Eur J Vasc Endovasc Surg. 2019; 58: 930-935https://doi.org/10.1016/j.ejvs.2018.11.003Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 5Benzing C. Fellmer P. Lateral Approach to the Distal Femoral Artery in Femoro-Anterior-Tibial Bypass Surgery.Eur J Vasc Endovasc Surg. 2016; 52: 267https://doi.org/10.1016/j.ejvs.2016.04.024Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar). A 74-year-old man, having Buerger's disease and arteriosclerosis obliterans, presented with extensive lymphatic fistula and necrosis of the groin (Fig.1) after right axillary artery to the right deep femoral artery bypass, which had been patented for last five years after the several revascularizations of iliac arteries and femoral arteries. Due to the several open surgeries, such as aorto-right external iliac artery bypass, aorto-left popliteal artery bypass, cholecystectomy and resection of gastric cancer, we chose right axillopopliteal artery bypass grafting, through the iliac wing. The skin incision was made along the iliac crest and the external oblique muscle fascia was separated to reach the pelvis, and a longitudinal incision was made anterosuperior to the greater trochanter to create a gluteal pathway to bypass the infected groin. 10-mm hole was made by shaving the bone about 4 cm from the iliac crest, and the graft was passed through the hole. (Fig 2). A lateral popliteal approach was selected for revascularization owing to extensive groin and medial thigh infective wounds. After that the extensive lymphatic fistula and necrosis were controlled with using negative pressure wound therapy.Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT) The postoperative course was uneventful, and contrast-enhanced computed tomography confirmed proper arrangement of the graft, without bending (Fig 3 and Fig 4). He was discharged from the hospital on the 14th postoperative day. The computed tomography which was taken one year later showed the patency of this graft. The combination of trans - iliac bypass and lateral popliteal approach was shown to be effective in this case of extensive groin and medial compartment infection, and can potentially be applied in similar future cases.Figure 4View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ghost Ileostomy Release Down-Our Initial Experience

Abstract Background Many publications describe the advantages of the creation of ghost ileostomy (GI) to prevent the need for formal covering ileostomy in more than 80% of carcinoma rectum patients. However, none of the papers describes exactly how to ultimately remove the GI in these 80% of patients in whom it doesn't need formal maturation. Aim To describe and evaluate the ghost ileostomy release down (GIRD) technique in terms of feasibility, complications, hospital stay, procedure time etc. in patients with low anterior resection/ultra-low anterior resection (LAR/uLAR) with GI for carcinoma rectum. Method The present was a prospective cohort study of patients with restorative colorectal resections with GI for carcinoma rectum, Postoperatively the patients were studied with respect to ease and feasibility of the release down of GI and its complications. The data was collected, analyzed and inference drawn. Results A total of 26 patients needed the GIRD and were included in the final statistical analysis of the study. The procedure was done between 7th to 16th postoperative days (POD) and was successful in all patients without the need of any additional surgical procedure. None of the patients required any local anesthetic injection or any extra analgesics. The average time taken for procedure was 5-minutes and none of the patients had any significant difficulty in GI release. There were no immediate postprocedure complications. Conclusion The GIRD technique is a simple, safe, and quick procedure done around the 10th POD that can easily be performed by the bedside of patient without the need of any anesthesia or additional analgesics.

Comparative Study of Placebo Versus Metronidazole as a Role of Pain Relief Post Hemorrhoidectomy

Objective: To assess the role of metronidazole versus placebo in terms of pain relief post hemorrhoidectomy. Methodology: This randomized control trial was done at the general surgery department of PUMHS from January 2022 to July 2022. The study included adult patients of both genders, aged 18-60, who underwent surgeries for grade III and grade IV hemorrhoids. The participants were divided into two groups: a control group and an intervention group that received oral metronidazole for seven days postoperatively. Both groups received a standardized post-operative analgesic treatment. Post-operative pain and its severity were assessed using the Visual Analog Scale (VAS). Data were collected using a study proforma, and statistical analysis was performed using SPSS version 26. Results: A total of 60 cases of hemorrhoids were comparatively studied; mean age of the case group was 39.36+10.43 years and the mean age of the control group was 35.33+9.35 years (p=0.120). The mean BMI and average disease duration was statistically insignificant according to both groups (p > 0.05). In the cases group, grade III hemorrhoids were 36.7% and grade IV hemorrhoids were 63.3%, while in the control group, grade III hemorrhoids were 46.7% and grade IV hemorrhoids were 53.3% (p=0121). The mean operative time was almost similar in both groups (p=0.515). Average VAS was significantly decreased in the case group after 2 hours, at 24 hours, at 36 hours, and at 48 hours (p=<0.05), while it was statistically insignificant according to both groups at the 7th post-operative day (p=0.091). Conclusion: The use of oral or topical metronidazole in the post-operative period concludes to be more effective in terms of clinically significant early pain relief.

BILATERALTEAT LACERATION AND ITS SUCCESSFUL SURGICAL MANAGEMENT IN HOLSTEIN FRIESIAN CROSSBRED CATTLE

A 5.5 years old Holstein Friesian crossbred cattle was presented with a history of traumatic injury by barbed metallic wire on right fore-teat six hours before. Clinical examination revealed full-thickness, bilateral, longitudinal laceration of the same teat, extending from base of the teat to the distal teat orifice with leakage of milk. Prompt reconstructive surgery was performed under sedation and local anesthesia to repair the laceration. The closure of the teat cistern was performed by suturing the laceration in three layers.Post-operative care included intra-mammary and systemicantibiotic therapy with NSAID for five consecutive days along with daily antiseptic dressing of the wound and regular drainage of milk via the fixed infant feeding tube in the teat cistern. The animal had shown uneventful recovery without any complication with removal of skin sutures on 10th post-operative day and started hand milking from the same teat on 20th post-operative day.

To Investigate the Association between the Extent of Lateral Internal Anal Sphincterotomy and Postoperative Fecal Incontinence in Individuals with Chronic Anal Fissure

Background: The primary objective of this investigation was to evaluate the prevalence of fecal incontinence after surgery in individuals who underwent open lateral internal anal sphincterotomy up to the dentate line compared to those undergoing anal sphincterotomy (open internal) up to the height of the anal fissure. Methodology: This study was randomized and controlled and was carried out in Abbasi Shaheed Hospital, Karachi, at the department of surgery between February 2021 and July 2022. The study enrolled patients who were 15 years or older and presented to the outpatient department with chronic anal fissure, regardless of gender. Patients with concomitant anal disease, those with previous history of anorectal surgery & those with systemic neurological disease leading to fecal incontinence were excluded. Analysis of the collected data was performed using SPSS version 23. For quantitative variables, such as age, standard deviation and mean were calculated. Conversely, the qualitative variables, such as gender, location of anal fissure, Browning and Park's classification of incontinence, and final outcome(i.e. fecal incontinence at 5th postoperative day), were assessed using percentages and frequency. Results: In this study, 198 individuals who are chorincally suffering from anal fissure were identified and divided into two groups, Group A and B, each consisting of 99 patients. Group A underwent an open lateral internal anal sphincterotomy up to the level of the dentate line (referred to as the "dentate line group"), while Group B received an open lateral internal anal sphincterotomy up to the height of the fissure (known as the "height of fissure group").Fecal incontinence was assessed and compared between both groups on 5th postoperative day by using Browning and Park’s classification. The findings of this investigation indicated that open lateral anal sphincterotomy up to the level of the dentate line was associated with an 11.1% incidence of fecal incontinence, while a 3% incidence of fecal incontinence was observed in individuals who underwent anal sphincterotomy (lateral internal) up to the height of the anal fissure. Practical Implication: present study suggests that lateral internal anal sphincterotomy up to the height of anal fissure may be associated with a lower risk of fecal incontinence compared to the dentate line group. Conclusion: The data obtained from this study suggested that open anal sphincterotomy (lateral internal) up to the height of the anal fissure was linked to reduced incidence rates of postoperative fecal incontinence on the fifth day after surgery, as compared to open anal sphincterotomy (lateral internal) up to the level of the dentate line. Therefore, this modification should be used in future regularly in order to reduce this morbidity. Keywords: Fecal incontinence, Chronic Anal Fissure, Sphincterotomy.

Indocyanine Green Fluorescence-Guided Laparoscopic Ureterolysis for Complex Gynecological Surgeries

Background: To identify and safeguard the ureters of patients with deep infiltrating endometriosis or complex pelvic adhesion (obliterated cul-de-sac) using indocyanine green (ICG) during laparoscopic surgery. Methods: Stepwise surgical demonstration using narrated video footage. The stepwise procedures were: (1) Explore the abdominal cavity, resect pelvic adhesions, remove the right ovarian endometrioma cysts, and open the peritoneum to locate the fluorescence. (2) Place bilateral 5-Fr ureteral catheters through the cystoscope, inject ICG retrogradely, and clip the catheter to retain the ICG. (3) Identify the course of ureters and perform ureterolysis with real-time visualization under Near-infrared fluorescence. Resect the para-ureteral endometriosis and other pelvic endometriosis. Results: The patient was discharged on the 4th postoperative day with satisfactory surgical effect and without any complications. Conclusions: For complex gynecologic surgeries whereby ureterolysis might be challenging, ICG fluorescence imaging could be used to quickly identify the course of the ureter, prevent ureteral injury and reduce the risks of perioperative and postoperative complications. This case demonstrates that intraureteral ICG provided quick visualization of the ureter and allowed surgeons to safely perform ureterolysis. The proposed technique could be considered in complex gynecological cancer, pelvic floor disorder or endometriosis surgery.

Зміна концентрації греліну при цукровому діабеті 2-го типу, асоційованому з ожирінням, після лапароскопічної рукавної резекції шлунка

Laparoscopic sleeve gastrectomy (LSG) is an effective method of treating obesity complicated by type 2 diabetes mellitus (T2DM). The performance of this metabolic surgical intervention involves removal fundus of the stomach, which in turn leads to an effect on the eating behavior of patients in the form of a decrease in appetite and loss of excess body weight with a parallel effect on the compensation of T2DM in the postoperative period, regardless of the loss of body weight. At present, mechanisms of T2DM compensation after LSG have not yet been clearly defined. The aim of our study was to study the effect of LSG on the dynamics of changes in the blood plasma ghrelin levels in patients with T2DM associated with obesity. The plasma ghrelin levels were assessed in the fasted state, 15, 30, 60, and 90 min after a standard breakfast carbohydrate preload, which included 125 ml of Nutricia Nutridrink, a balanced high-energy protein. The examination was carried out before the operation, on the 4th postoperative day and 3 months after the operation. 7 patients were diagnosed with T2DM for the first time, 3 had a history of diabetes for 2 years, one patient had a history of 3.5 years, and another had a history of 10 years. The average content of glycated hemoglobin before the operation was 7.7%, 3 months after LSG - 5.9%. The fasting ghrelin concentration before LSG performing was 6.8 ng/ml, on the 4th postoperative day – 4.6 ng/ml, and 3 months after the operation – 4.4 ng/ml (P = 0.001) in comparison with preoperative indicators). The peak insulin concentration was noted 30 min after the carbohydrate preload 3 months after the operation and was 175.1 μU/ml, and its fasting levels in the postoperative period reached a statistically significant difference compared to the preoperative values (30 μU/ml before surgery and 25.3 μU/ml 3 months after LSG). Thus, LSG leads to an early and significant suppression of fasting ghrelin secretion in patients with obesity-associated T2DM and likely to restore insulin secretion and/or reduce insulin resistance. Rapid postoperative improvement of carbohydrate metabolism components indicates the importance of the early reduction of ghrelin secretion in combination with the incretin effect of LSG in the implementation of the mechanisms of early compensation of T2DM and explains the metabolic activity of this operation and the significant role of the stomach in the regulation of glucose metabolism.

(112) An Experimental Animal Study of the Histopathological Effect of Collagen Fleece (TachoSil) Patch of Tunica Albuginea Defects Associated with Penile Surgery

Abstract Introduction A penile tunica defect may arise during penile prosthesis surgery or reconstruction of the penis in patients with Peyronie’s disease. Collagen fleece (TachoSil) was recently reported in penile surgery to cover the tunica defect with reported clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. Objective We study the novel application of TachoSil graft in an experimental animal model. We looked at the regeneration of tunica albuginea, development of inflammation and fibrosis, and histopathological effect on the underlying cavernous tissue. Methods Seven adult male Sprague Dawley rats were used. All procedures were carried out under general inhalation anesthesia. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1x10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect in six rats and Surgicel (Ethicon) in one. The penile skin covering is then restored and fixed with interrupted 5-6 zero absorbable sutures. At two months, the rat penis was evaluated for excision. Euthanasia was carried out with an overdose of inhalation anesthesia and chest opening. The excised penis was examined by hematoxylin and eosin and trichrome stains. Results At the time of surgery, the rats’ weight was 390 gm (SD 33.8). All rats with TachoSil showed normal-looking penis at two months with complete healing, no scaring, tethering, or gross inflammatory features. The penis of three rats with a Tachosil patch was harvested at two months postoperatively. It showed histopathology of fibrosis, chronic inflammation, and foreign body giant cell reaction at the site of the patch. There was no generation of a new tunica albuginea, no new vascularity or distinct fibrous layer development. The underlying corpus cavernous tissue was not affected by any inflammatory or pathological reaction. One rat died on the 6th postoperative day. Postmortem showed massive gastrointestinal bleeding, intraperitoneal hemorrhage, and punctate hemorrhages of the parenchyma of both suprarenal glands, both kidneys, and the liver. A clinical diagnosis of DIC was made. Histopathology of the penis, however, did not show micro thrombosis. The fifth rat with a Surgicel patch showed immediate hematoma of the penis controlled by compression. After two months, during harvesting of the penis, large pockets of pus were seen spreading from the site of the patch to surrounding structures. Histopathology showed chronic inflammation and fibrosis extending into the corpus cavernosum. The sixth and seventh rats showed normal penis external appearance at two months and were left surviving for harvest at four months. Conclusions Tachosil patching of penile tunica albuginea defect forms a distinctive barrier against inflammation protecting the underlying corpus cavernosum. However, no regeneration of tunica defect is observed at two months. DIC is a potential complication of systemic absorption of TachoSil. Disclosure No

Repair using the pectoralis major musculocutaneous flap for refractory anastomotic leakage after total esophagectomy

BackgroundThe pectoralis major musculocutaneous flap (PMMF) is a pedicled flap often used as a reconstruction option in head and neck surgery, especially in cases with poor wound healing. However, applying PMMF after esophageal surgery is uncommon. We report here, the case of a successfully repaired refractory anastomotic fistula (RF) after total esophagectomy, by PMMF.Case presentationA 73-year-old man had a history of hypopharyngolaryngectomy, cervical esophagectomy, and reconstruction using a free jejunal graft for hypopharyngeal carcinosarcoma at the age of 54. He also received conservative treatment for pharyngo-jejunal anastomotic leakage (AL), then postoperative radiation therapy. This time, he was diagnosed with carcinosarcoma in the upper thoracic esophagus; cT3rN0M0, cStageII, according to the Japanese Classification of Esophageal Cancer 12th Edition. As a salvage surgery, thoracoscopic total resection of the esophageal remnant and reconstruction using gastric tube via posterior mediastinal route was performed. The distal side of the jejunal graft was cut and re-anastomosed with the top of the gastric tube. An AL was observed on the 6th postoperative day (POD), and after 2 months of conservative treatment was then diagnosed as RF. The 3/4 circumference of the anterior wall of the gastric tube was ruptured for 6 cm in length, and surgical repair using PMMF was performed on POD71. The edge of the defect was exposed and the PMMF (10 × 5 cm) fed by thoracoacromial vessels was prepared. Then, the skin of the flap and the wedge of the leakage were hand sutured via double layers with the skin of the flap facing the intestinal lumen. Although a minor AL was observed on POD19, it healed with conservative treatment. No complications, such as stenosis, reflux, re-leakage, were observed over 3 years of postoperative follow-up.ConclusionsThe PMMF is a useful option for repairing intractable AL after esophagectomy, especially in cases with large defect, as well as difficulties for microvascular anastomosis due to previous operation, radiation, or wound inflammation.

Transient flank bulge after percutaneous nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) is considered as the “gold standard” treatment for large (>2 cm) and complex kidney stones. We present a case of transient tone loss of the anterolateral abdominal wall, which is a rare complication after PCNL. Case Report: A 50-year-old male with a complete staghorn stone of the right kidney underwent standard PCNL in prone position at the 11th intercostal space. On the 6th post-operative day the patient complained on painless bulge in the right flank. Computed tomography (CT) scan in supine position revealed no signs of herniation, retroperitoneal hematoma, or residual fragments. Flank bulge was attributed to the muscle tone loss either because of the 11th intercostal nerve injury by the needle or nerve compression by the Amplatz sheath. Within next six months flank bulge has completely resolved. Conclusion: Flank bulge after PCNL although rare but possible and transient condition. Nerve injury seems to be the most likely cause.

P192 POSTINFARCTION VENTRICULAR SEPTAL DEFECT: MANAGEMENT AND A NEW SURGICAL OPTION FOR CLOSURE

Abstract Postinfarction ventricular septal defect is a rare mechanical complication of myocardial infarction, with difficult management, debated closure timing and high mortality rates. Standard repair techniques – infarcectomy and infarct exclusion through a left ventriculotomy – are surgically challenging and have high risk of operative mortality and frequently suboptimal results. We report the case of a 66–year–old patient with a 1.4 cm septal rupture developed after a sub–acute STEMI. At the admission, he had chest pain and moderate dyspnoea, EKG showed inferior STEMI with increased myocardial necrosis markers. Echocardiography showed a preserved ejection fraction, akinesia of the inferior, posterolateral walls and of the posterobasal septum, with septal rupture at this level and 1.5 Qp/Qs ratio. A total occlusion of proximal right main coronary artery was found at coronary angiography. After the heart team meeting, we performed a new modified closure, in urgent setting, using two hand–made composite patches (Fig. 1) parachuted through a transversal aortotomy and a right atriotomy, without left ventriculotomy (Fig. 2). In the 7th postoperative day a second septal rupture was detected at the echocardiographic control. After two weeks follow–up in optimized medical therapy, we decided to complete the closure of the later developed septal rupture percutaneously using an Amplatzer device. Six months after the event, the patient is still asymptomatic and echocardiography documents a 50% ejection fraction, with trivial residual left–to–right shunt and normal valve function. Computed tomography scans confirmed optimal surgical result. Timing, management and surgical strategy are still on debate. Our technique is effective, simple, reproducible and provides good result (Fig. 3) and can be perfectly integrated in a hybrid approach.

P165 ARRHYTHMIC STORM IN SUBACUTE MYOCARDIAL INFARCTION: A CASE REPORT

Abstract Introduction Ventricular arrhythmias (VA) represent a common complication of myocardial infarction (MI). Typically, they occur in two scenarios: during acute MI, related to ongoing ischemia, as ventricular tachycardia (VT) or ventricular fibrillation (VF), or in the context of a late phase of MI, related to the presence of a scar, as monomorphic VT (mVT). Despite the above, their occurrence may be atypical. Clinical Case 55–year–old man affected by obesity, diabetes and hypertension, admitted to our department for subacute MI. Coronarography showed three–vessel disease with indication for surgical revascularization. Thirty hours after admission, in absence of symptoms, occurrence of cardiovascular arrest due to mVT, which degenerated into VF. After resuscitation, ECG and Echo findings did not change compared to those observed at admission, excluding the presence of current ischemia. A blood gas analysis excluded dysionias. Few minutes later, arrhythmic recurrence of mVT degenerated into VF. This was refractory to electrical and antiarrhythmic therapy and stopped only after percutaneous left stellate ganglion block (LSGB) and deep sedation. Then, emergency surgical revascularization was performed. In the early postoperative days, during weaning attempts from sedation and ECMO support, that had become necessary due to hemodynamic instability after surgery, numerous recurrences of mVT, regressed only after deepening of sedation, multiple external shocks, antiarrhythmic polytherapy, and LSGB. A new coronarography documented patency of coronary artery bypass grafts. On 6th postoperative day, discontinuation of deep sedation and weaning from circulatory support without recurrence of VA. The patient was discharged from the intensive care unit and started on a rehabilitation pathway. Conclusions mVTs are commonly related to the presence of a scar, formed late after MI, or to the context of ongoing ischemia in acute MI. However, it should be remembered that even during the subacute phase of MI, arrhythmic instability might still occur. The responsible mechanisms are not completely known but it can be assumed that, even in the absence of a new ischemic event, the process of scar maturation may have led to a transient proarrhythmic substrate, responsible for the arrhythmic storm. Further studies are needed to clarify the mechanisms of arrhythmogenesis in the subacute phase of MI.

P48 PATIENT SELECTION FOR TRANSCATHETER TRICUSPID ANNULOPLASTY: CASE PRESENTATION

Abstract Clinical case We describe the case of an 87–year–old woman, BSA 1.7 m2, affected by arterial hypertension, atrial fibrillation, COPD, stage III chronic renal failure. The patient underwent aortic valve replacement with a biological prosthesis. The patient had good quality of life. n the last year, the patient had had two hospitalizations for right heart failure, with a home dose of Furosemide of 250 mg/day. A transthoracic echocardiogram, performed in outpatient setting, showed massive tricuspid regurgitation (ERO 0.8 cm2), TAPSE 21 mm, S TDI 0.12 cmc/sec, LVEF 55%, sPAP 40 mmHg (RHC). The TRISCORE (specific risk score for tricuspid pathology) was equal to 8%, therefore at a high preoperative risk. The case was collectively discussed in the Heart Team and we decided for transcatheter treatment of the isolated tricuspid pathology. A transesophageal echocardiogram confirmed the severity of the tricuspid regurgitation, characterized by multiple jets of which the prevalent central and posteroseptal. The coaptation gap was 10 mm, with partial retraction of the septal flap. Therefore, the possibility of an edge–to–edge treatment was excluded and the screening for annuloplasty device evaluation (Cardioband) continued. Cardio–CT showed feasibility for Cardioband with adequate implant safety and distance from the right coronary artery. Therefore, a Cardioband (Edwards Lifesciences) was implanted in the tricuspid position. The procedural time was 220 minutes. The final result was tricuspid regurgitation less than grade 2 (R vol 30 mL/beat, EROA 0.2). The patient was discharged on the 4th postoperative day. At the 30–day follow–up, he was in NYHA class I–II, with a furosemide dose of 75 mg/day, in the absence of peripheral edema. Conclusions Patients with isolated tricuspid regurgitation are, in most cases, not treated due to the high postoperative surgical risk. In recent years, transcatheter technologies have been a valid solution in the event of inoperability. Where a treatment on the valve leaflets is not feasible, tricuspid annuloplasty represents a valid alternative.

Delayed extensive surgical emphysema after Valsalva manoeuvre post Eustachian tuboplasty.

This paper reports a case of balloon Eustachian tuboplasty with delayed presentation of extensive surgical emphysema. This is a clinical case report with a review of literature. Eustachian tube dysfunction is a functional disorder that results in inadequate middle-ear ventilation, causing aural fullness and tinnitus. A 36-year-old male presented with the sudden onset of an isolated, painful, left-sided neck swelling. The patient underwent balloon Eustachian tuboplasty, which was uneventful, but subsequently developed a sudden onset of isolated left-sided neck swelling on the 5th post-operative day during Valsalva manoeuvre. Neck examination revealed extensive crepitus on the left side of the neck. Examination findings were confirmed by imaging. The patient was conservatively managed and subsequently discharged home. Balloon Eustachian tuboplasty is a safe procedure; however, extra care must be taken to avoid possible complications. Patients should be counselled against Valsalva manoeuvre and heavy weightlifting. They also should be instructed to sneeze with an open mouth and consider the use of stool softeners.

Repair of eyelid margin defects with diagonal tarsal suture technique.

Evaluation of the results of diagonal suture technique in full-thickness eyelid margin repair in the early recovery period. In this study, full-thickness eyelid margin repair cases using a diagonal suture technique between February 2016 and March 2020 were reviewed retrospectively. Cases due to trauma were not included in the study. Patients were evaluated on the 1st, 6th and 30th day following surgery. The demographic information of the patients, the surgery performed, the level of the lid margin (normal healing, notching), and the presence of tissue reaction (edema, redness, tissue separation, abscess formation) were recorded. Nine (47.4%) out of 19 patients were female and 10 (52.6%) were male. Their ages ranged from 56 to 83 (median: 66). Of the 19 surgeries performed, 14 were Quickert, 3 were pentagon excision, and 2 were Lazy-T. Edema was observed in 3 cases (15.8%) on the first day. Tissue reaction was not observed in any of the cases in neither the first week nor the first month. Although the lid margin healed properly in each case, notching was observed on the inner surface of the lid margin on the 1st and 6th postoperative days in 1 (5.3%) patient. During the 30th-day follow-up visit, it was observed that the notching had decreased. The advantages of diagonal suture technique are having no sutures that may touch the cornea at the lid margin and resulting in a better cosmetic appearance in the early postoperative period. It is an easy, effective and reliable method to apply.

Oxidative Stress and Inflammation Biomarkers in Postoperative Pain Modulation in Surgically Treated Patients with Laryngeal Cancer—Pilot Study

(1) Background: Surgical treatment of laryngeal carcinoma includes different types of laryngectomies with neck dissection. Surgical tissue damage triggers an inflammatory response, leading to the release of pro-inflammatory molecules. This increases reactive oxygen species production and decreases antioxidant defense mechanisms, leading to postoperative oxidative stress. The aim of this study was to assess the correlation between oxidative stress (malondialdehyde, MDA; glutathione peroxidase, GPX; superoxide dismutase, SOD) and inflammation (interleukin 1, IL-1; interleukin-6, IL-6; C–reactive protein, CRP) parameters and postoperative pain management in patients surgically treated with laryngeal cancer. (2) Methods: This prospective study included 28 patients with surgically treated laryngeal cancer. Blood samples were taken for the analysis of oxidative stress and inflammation parameters before the operative treatment and after the operative treatment (1st postoperative day and 7th postoperative day). The concentrations of MDA, SOD, GPX, IL-1, IL-6, and CRP in the serum were determined by coated enzyme-linked immunosorbent assay (ELISA). The visual analog scale (VAS) was used for pain assessment. (3) Results and conclusion: There was a correlation between oxidative stress and inflammation biomarkers and postoperative pain modulation in surgically treated patients with laryngeal cancer. Age, more extensive surgery, CRP values, and use of tramadol were predictors for oxidative stress parameters.

Value of prolonged scrotal drainage after penile prosthesis implantation: a multicenter prospective nonrandomized pilot study.

We aimed to understand the risks and benefits of post-inflatable penile prosthesis (IPP) implantation drainage and optimal duration. Our patients were divided into 3 groups: Group 1 (n = 114) had no drain placed, Group 2 had a drain placed for 24 h (n = 114) and Group 3 had a drain placed for 72 h (n = 117). Postoperative scrotal hematoma and prosthesis infection rates were compared between the groups. The patients from Group 3 demonstrated a statistically significant lower incidence of hematoma on the 10th postoperative day: (n = 1, 0.9%) compared to Group 2: (n = 11, 9.6%) and Group 1: (n = 8, 7%), (p = 0.013). However, on the 3rd postoperative day, there was a statistically significant lower incidence of hematoma in both Groups 3 and 2: (0.9% and 6.1%, respectively) vs. Group 1: (11.4%), (p = 0.004). Hematoma rates followed the same group order after the first day of surgery: 1.7% (n = 2), 5.3% (n = 6), and 8.8% (n = 10), respectively, (p = 0.05). Five patients (4.4%) in Group 1 and four patients (3.5%) in Group 2 developed an IPP associated infection, opposed to only a single patient (0.85%) in Group 3, (p = 0.210). We concluded that prolonged scrotal drainage for 72 h after virgin IPP implantation significantly reduces hematoma and infection rates.

OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR

Abstract Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p <0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p <0.001) and pain on the first and 10th postoperative days were significantly lower (p <0.001), while the operative time was significantly longer (p <0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.