7th Postoperative Day Research Articles

Case report on a retroperitoneal sarcoma encasing left common iliac vein in a 65 years old elderly woman

A 65 years old married female patient presented to us with chief complaints of dull aching back pain, radiating upto left thigh since 1 year. MRI pelvis revealed a large heterogeneous solid lesion in retroperitoneum in the paravertebral region. Intraoperatively, the mass was encasing the Left Common Iliac Vein which was lighted. Since, the presentation was chronic the venous collaterals in the left lower limb was already formed and there was no need for venous reconstruction. The Left lower limb did not suffer any complications and the patient was discharged on 10th post operative day. When there is chronic obstruction of Common Iliac Vein, usually venous collaterals develops and the lower limb can be salvaged without venous reconstruction.

Point-Prevalence Survey for the Hospital-Acquired Infections and Infection Prevention and Control Status of Different Wards of Rajshahi Medical College Hospital

Introduction: Healthcare-associated infections represent significant obstacles to providing high-quality healthcare and have been directly linked to ineffective infection control procedures. There is currently a shortage of trustworthy data in Bangladesh describing the epidemiology of hospital-acquired infections (HAIs), which is necessary for the development of effective infection prevention and control measures. This study's goal was to assess the frequency, nature, and risk factors of HAIs in acute care hospitals in Northern Bangladesh.
 Methods: This was a pilot point prevalent survey conducted in the medicine, surgery, gynecology, and obstetrics departments of Rajshahi Medical College Hospital between August 2022 to September 2022. Data were collected by two questionnaires for disease profile and hospital-acquired infection. In addition, a checklist was used for the observation of the infection prevention and control (IPC) status of different wards.
 Result: Approximately 900 patients' data were collected during this time period. The overall prevalence of HAI was found to be 3.7%. The prevalence of HAI, especially surgical site Infection (SSI), in the obstetrics ward, was 4.2%, and the Medicine ward was 3.9%, respectively. The prevalence of hospital-acquired infection in the surgery ward is 7.7%. Approximately 41.7% of patients developed SSI on the 6th post operative day (POD). The Infection prevention and control status of different wards was similar, which was not satisfactory.
 Conclusion: This surveillance might help concerned authorities and policymakers by making some crucial steps to monitor and reduce hospital-acquired infections and HAIs in hospitals.
 TAJ 2022; 36: No-1: 9-15

Effectiveness of 5-Fluorouracil and Hypertonic Glucose in the Prevention of Post-mastectomy Seroma in an Experimental Animal Model.

Seroma is a frequent complication that can affect the final result of reconstructive and cosmetic surgeries. This study evaluated the effectiveness of 5-Fluorouracil and 75% hypertonic glucose in preventing seroma in a mastectomy rat model, as well as cellular and vascular events in adjacent tissues. A left mastectomy with lymphadenectomy was performed in 60 Wistar-Albino female rats. Animals randomly allocated to the control group (Group I; n = 20) were sutured right after mastectomy. The intervention groups received 1.0 mL of 75% hypertonic glucose (Group II; n = 20) or 1.0 mL of 5-Fluorouracil (Group III; n = 20) at the surgical site before suturing. The assessment of the presence of seroma was performed in all animals at 24, 48, and 72 h and on the 7th and 12th postoperative day. After the 12th day, a tissue sample was taken from the surgical site and sent for histological analysis. The occurrence of seroma was assessed using GEE. A significance level of 5% was adopted. Differences in seroma formation over time were observed for both Control Group I (p=0.041) and Intervention Group II (p<0.001). In Intervention Group III, there was no difference in the percentage and volume of seroma across the assessment points (p=0.627). When both the Control and Intervention Group II were compared to Intervention Group III, we found a reduction in seroma formation in the last group. The reduction in the inflammatory process was more regular to Intervention Group III. In this animal model, 5-Fluorouracil was more effective in preventing seroma formation than 75% Hypertonic Glucose. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

113 Exploratory laparoscopy in suspected bowel obstruction secondary to a transmesenteric hernia

Abstract Background Transmesenteric hernias (TH) in adults are an uncommon subtype of internal hernia that can be life-threatening because of the risk of bowel ischemia if not correctly diagnosed. Case report A 79-year-old man came to the emergency department with abdominal pain associated with vomiting and constipation for 24 hours. Physical examination showed no alarm signs. However, due to the presence of leukocytosis with neutrophilia and an abdominal X-ray with suspected obstruction, an abdominal CT scan was requested. Given the radiological finding of a defect in the mesentery through which a portion of the mesentery and several loops of bowel were introduced, an exploratory laparoscopy was indicated on suspicion of TH. Intraoperatively, 150 cm from the ileocecal valve, a 30 cm congestive segment of jejunum was observed, which was inserted in a 4 cm long eyelet in the omentum. Reduction of the herniated small bowel loops through the eyelet was performed without difficulty, observing good viability of the loops, and the eyelet was opened with scissors leaving the omentum open at the distal end. The patient was discharged on the 5th postoperative day tolerating oral diet, with transit and the surgical wound without signs of infection. Conclusion Although CT is the best diagnostic test for TH its preoperative diagnosis remains difficult. In the case of suspected TH, early exploratory laparoscopy is a correct technique that can preserve the viability of the bowel.

Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial.

This randomized clinical trial aimed to compare the efficacy of Erich arch bars (EAB) and intermaxillary fixation (IMF) screws in reducing mandibular fractures during open reduction and internal fixation (ORIF). A total of 28 patients with mandibular fractures were randomly allocated to either the EAB group or the IMF screws group. The study evaluated various parameters including occlusal stability, complications, duration of application, oral hygiene status, quality of life, and patient characteristics. The study found no significant differences in occlusal stability between the EAB and IMF screw groups. However, the application and removal times were longer for EAB compared to IMF screws. The EAB group showed a higher presence of biofilm on teeth, indicating poorer oral hygiene status compared to the IMF screws group. In terms of quality of life, patients in the EAB group reported worse results in the "handicap" domain at the 15th postoperative day. No significant differences were observed in other quality-of-life parameters. Patient characteristics were well distributed between the two groups, enhancing the reliability of the results. Both EAB and IMF screws demonstrated comparable occlusal stability for minimally displaced mandibular fractures. However, IMF screws offered advantages such as shorter application and removal times, better oral hygiene maintenance, and potentially improved quality of life in the "handicap" domain. Further studies with larger sample sizes are necessary to validate these findings and explore the stability of IMF methods in cases requiring postoperative malocclusion correction or prolonged IMF.

118 Bouveret Syndrome: A Rare Case of a Huge Gallstone causing Gastric Outlet Obstruction

Abstract Introduction Bouveret syndrome is a rare case of gallstone ileus resulting from an acquired fistula connecting the gallbladder and either the stomach or duodenum and cause intestinal obstruction. Case Summary A 85-year-old female presented with epigastric pain non-bilious vomiting and absolute constipation for five days. She patient was tachycardiac and was dehydrated. Abdomen was distended. Bowel sounds were absent. Digital rectal examination was unremarkable. Abdominal radiography did not demonstrate pathological air-fluid levels, rather revealed a dilated gastric shadow, suggestive of gastric outlet obstruction. The patient was immediately managed with nasogastric intubation and intravenous hydration. Subsequent esophagogastroduodenoscopy (EGD) was planned to rule out carcinoma owing to the age of the patient. EGD revealed a dilated stomach and a hard, golf-ball-sized gallstone in the third part of the duodenum. The scope could not be passed beyond the impacted stone, nor could it be extracted endoscopically. CT tomography revealed a distended stomach with a large gallstone obstructing duodenum and pneumobilia . One-stage surgical procedure was planned. Intraoperative findings included a thick-walled gallbladder with surrounding inflammation and a fistulous tract connecting the gallbladder with the duodenum. A gallstone measuring 3.7cm in diameter was retrieved from the third part of duodenum via enterotomy. The fistulous tract was closed, and cholecystectomy was performed and drain was placed. Patient was discharged on 4th postop day. Conclusion Bouveret syndrome is an infrequent presentation causing gastric outlet obstruction and is often overlooked owing to its rarity. High index of suspicion is necessary when patients present with bowel obstruction and a history of gallstones to prevent morbidity and mortality from Bouveret syndrome.

Assessment of impaired cerebral autoregulation and its correlation with neurological outcome in aneurysmal subarachnoid hemorrhage: A prospective and observational study.

Cerebral autoregulation (CA) is crucial for the maintenance of cerebral homeostasis. It can be assessed by measuring transient hyperemic response ratio (THRR) using transcranial Doppler (TCD). We aimed at assessing the incidence of impaired CA (ICA) and its correlation with the neurological outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). One hundred consecutive patients with aSAH scheduled for aneurysmal clipping were enrolled in this prospective and observational study. Preoperative and consecutive 5-day postoperative THRR measurements were taken. Primary objective of the study was to detect the incidence of ICA and its correlation with vasospasm (VS) postclipping, and neurological outcome at discharge and 1, 3, and 12 months was secondary objectives. ICA (THRR < 1.09) was observed in 69 patients preoperatively, 74 patients on the 1st and 2nd postoperative day, 76 patients on 3rd postoperative day, and 78 patients on 4th and 5th postoperative day. Significant VS was seen in 13.4% and 61.5% of patients with intact THRR and deranged THRR, respectively (P < 0.000). Out of 78 patients who had ICA, 42 patients (53.8%) at discharge, 60 patients (76.9%) at 1 month, 54 patients (69.2%) at 3 month, and 55 patients (70.5%) at 12 months had unfavorable neurological outcome significantly more than those with preserved CA. Incidence of ICA assessed in aSAH patients varies from 69% to 78% in the perioperative period. The deranged CA was associated with significantly poor neurological outcome. Therefore, CA assessment using TCD-based THRR provides a simple, noninvasive bedside approach for predicting neurological outcome in aSAH.

Renal artery aneurism and renal autotransplantation: review of surgical technique, preoperative complementary examinations and postoperative follow-up protocol

Introduction: Renal artery aneurysm (RAA) is a rare pathology; however, its incidental diagnosis is increasingly frequent due to the increasing use of imaging techniques. Complex (hilar) RAAs, dependent on the distal renal artery and its branches, constitute a subset of RAAs that present a therapeutic challenge due to their anatomical location and may require extracorporeal arterial repair and autotransplantation. Material and methods: A bibliographic review is carried out to homogenize the management of this pathology, analyzing the indications for surgical treatment, the recommended surgical technique step by step, as well as post-surgical monitoring. Two clinical cases of RAA treated in our center by hand-assisted laparoscopic nephrectomy, ex vivo bench repair and renal autotransplantation are presented. Results: In both cases, a postoperative Doppler ultrasound of the graft was performed 24 hours later, in which a renal graft was observed in the iliac fossa, of normal size and cortical thickness within normality with normal color Doppler signal, and spectral curves without alterations. Both patients presented oligoanuric acute renal failure (injury) during the immediate postoperative period (first 24 hours) with complete resolution at discharge, which occurred on the 11th and 12th postoperative day, respectively. In both patients a diuretic renogram with MAG3 was performed. In case 1, it was performed the third postoperative month and a slightly ectatic right kidney was observed with less perfusion and parenchymal incorporation of the radiotracer, with a reduction in relative renal function (39.47%) and MAG3 clearance (indeterminate renographic pattern). In this patient, a CT scan with the excretory phase was performed simultaneously, in which a grafted right kidney was seen at the level of the right iliac fossa with good contrast elimination in the excretory phase bilaterally and symmetrically. A small non-perfused area is observed in the upper pole. In the second patient, the renogram was performed on the 14th postoperative day, finding the morphofunctional study of the graft within normal parameters without detecting areas of hypoperfusion. The levels of creatinine and glomerular filtration were, respectively, in the first case: 0.86mg/dl and 90.19ml/min/1.73m2 preoperatively and 0.83mg/dl and 90.96ml/min/ 1.73m2 per postoperative month. In the second case, the values were: preoperatively creatinine of 0.66mg/dl and glomerular filtration rate of 97.96ml/min/1.73m2 and 0.81mg/dl and 89ml/min/1.73m2 one month postoperatively. Conclusion: After reviewing the literature, there is no consensus regarding the imaging techniques to be performed after renal autotransplantation and the optimal time frames for performing these for the evaluation of the postoperative graft. There is also no homogeneity in the imaging techniques to be performed in the preoperative assessment. In our experience, open ex vivo surgical repair of complex distal hilar RAAs has been successful with low morbidity and mortality and an acceptable rate of preservation of renal function.

Chitosan thread in the healing of the cecal wall of rabbits (Oryctolagus cuniculus) submitted to cecorrhaphy.

The development and evaluation of synthesis materials are crucial to reducing the morbidity and magnitude of post-enterorrhaphy surgical complications. Despite the possibility of production, chitosan thread has not yet been used in enterorrhaphy, and its effects on intestinal healing have not been evaluated. Therefore, this study aimed to evaluate the effects of chitosan thread on the intestinal wall repair of rabbits submitted to cecorrhaphy. For this, 42 rabbits were allocated into two groups with 21 animals. One group was submitted to cecorrhaphy with chitosan suture thread (CG) and the other with poliglecaprone suture thread (PG). The occurrence of postoperative complications, the intensity of edema, cellular response, formation of granulation tissue, as well as the deposition and maturation of collagen fibers, and the intensity of vascular endothelial growth factor (VEGF-α) expression, were evaluated during the intestinal wall repair process. The evaluations occurred on the 5th, 15th, and 25th postoperative (PO) days. The animals did not develop peritonitis, but adherence was observed in six animals from CG and seven from PG, with no difference between groups. The polymorphonuclear infiltrate showed higher intensity and higher amount of type III collagen fibers in CG on the 15th PO day. In contrast, a lower amount of type I collagen fibers was observed in CG samples on the 25th PO day. Therefore, the chitosan thread used for cecorrhaphy in rabbits results in minimal postoperative complications, presents biocompatibility, and bioactively assists the tissue repair process of the cecal wall, inducing minimal tissue reaction, stimulating the deposition of type III collagen fibers in the proliferative phase, with sustained VEGF-α expression, but with reduced deposition of type I fibers, indicating a delay in collagen maturation.

Combined Effects of Continuous Positive Airway Pressure and Cycle Ergometer in Early Rehabilitation of Coronary Artery Bypass Surgery Patients.

To determine the combined effects of continuous positive airway pressure (C-PAP) and physical exercise rehabilitation on a cycle ergometer on postcoronary artery bypass surgery patients. Randomised controlled trial. Place and Duration of the Study: Rawalpindi Institute of Cardiology, from December 2020 to May 2021. Patients, who underwent coronary artery bypass graft surgery, were divided into two equal groups of each 51. The control group received standard physiotherapy from the 1st postoperative day which included breathing exercises, passive mobilisation in the sitting position, and ambulation. The interventional group also had standard physiotherapy from 1st postoperative day; but also the 2nd to 4th postoperative day had additional dynamic exercises on cycle ergometry in combination with CPAP (continuous positive airway pressure). There was a significant improvement in functional capacity measured by 6-minute walk test in the interventional group (p<0.001). Length of hospital and ICU stay mean rank (68.88 and 58) were also significantly decreased in the interventional group (p<0.001). There was no improvement in maximum inspiratory pressure and maximum expiratory pressure. One-minute sit-to-stand test was increased on 4th postoperative day in the interventional group. There was no significant difference observed in arterial blood gases between these two groups. Cycle ergometry combined with continuous positive airway pressure (C-PAP) applied earlier on patients undergoing coronary artery bypass grafting improves the functional capacity, decreases the ICU and hospital length of stay and also improves lower limb muscle strength. But no difference in respiratory muscle strength and arterial blood gases was observed between the control and interventional groups. Aerobic exercise, Coronary artery bypass graft surgery, Continuous positive airway pressure.

Successful resuscitation from acute coronary syndrome during mediastinoscope-assisted transhiatal esophagectomy: a case report

BackgroundAlthough unexpected cardiac arrest is a very rare intraoperative complication, strategies regarding preoperative screening and procedures to be taken in the event of an emergency need to be well established.Case presentationA man in his late 70 s diagnosed with thoracic esophageal cancer, cT3N1M0, and cStage III was admitted. His metabolic equivalents were 4 or more. Electrocardiogram (ECG), ultrasound cardiography, and hematological examinations revealed no severe abnormalities. Computed tomography (CT) showed highly calcified coronary arteries. We performed mediastinoscope-assisted transhiatal esophagectomy. Procedures in the mediastinum involving access from the neck and abdomen were completed uneventfully. Middle mediastinal lymph node dissection and gastrointestinal reconstruction with the patient in the prone position were scheduled for later. However, before the change in position, pulseless nonsustained ventricular tachycardia (VT) suddenly occurred and caused blood pressure to drop sharply to below 30 mmHg. The VT disappeared in approximately 20 s, and there was a return to sinus rhythm after cardiac resuscitation; however, the ECG showed a decrease in the ST segments of leads II, III, and aVF. Immediately thereafter, the patient was transferred to the cardiac catheterization laboratory for percutaneous coronary intervention. Cardiac catheterization revealed diffuse stenosis of 90% in the left anterior descending branch of the coronary artery (segment no. 6). Plain old balloon angioplasty and stent placement were performed. Dual antiplatelet therapy was needed. On the next day, thoracoscopic esophagectomy was performed in the left lateral decubitus position, followed by cervical esophagostomy in the supine position. He developed acute respiratory distress syndrome and thoracic aortic dissection on the 5th postoperative day (POD) and intraperitoneal bleeding on the 16th POD. On the 105th POD, laparoscopic-assisted cervical esophagogastric anastomosis was performed. Parkinson’s disease was diagnosed on the 126th POD. On the 313th POD, the patient was discharged.ConclusionSurgeons should be familiar with the guidelines for patient screening and management of intraoperative cardiac arrest. In patients with severe coronary artery calcification, further investigation such as coronary angiography CT may be necessary before esophagectomy. Furthermore, highly invasive surgery should be performed in well-equipped hospitals.

A study of the histopathology of collagen fleece (TachoSil) patching of tunica albuginea in the rat penis and a literature review of penile graft materials in experimental animals.

A penile tunica defect may arise during surgery in patients with Peyronie's disease. Collagen fleece (TachoSil) has recently gained popularity in penile surgery to cover the tunica albuginea (TA) defect associated with clinical success. However, it is not known what the histological outcomes of these grafts are in the penis. We aimed to study the histopathology of the TachoSil graft in an experimental animal model for the regeneration of TA, inflammation, fibrosis, and the underlying cavernous tissue. Six adult male Sprague Dawley rats were used. The penis was degloved through a circumferential subcoronal incision. A longitudinal 1 mm × 10 mm defect was created at the base of the lateral aspect of the penis. A TachoSil patch (Takeda, Japan) was applied to the defect. The penile skin covering was then restored. At 2 months, the rat penis was excised and examined with hematoxylin, eosin, and trichrome stains. We conducted a literature review of penile grafts in animals for comparison. Rats weighed 369.2 gm (standard deviation: 31.5). At 2 months, all rats showed normal-looking penis with complete healing, no scaring, tethering, or gross inflammatory features. Histopathology of the patch site showed fibrosis, chronic inflammation, and foreign body giant cell reaction. There was no generation of a new TA, or new vascularity. No inflammatory or pathological reaction affected the underlying corpus cavernous tissue. One rat died on the 6th postoperative day. Postmortem showed massive multiorgan hemorrhage consistent with disseminated intravascular coagulopathy (DIC). Unlike some other reported grafts, there is no TA regeneration. TachoSil patching of penile TA defect forms a distinctive barrier against inflammation, protecting the underlying corpus cavernosum. However, no regeneration of the tunica defect is observed at 2 months. DIC is a potential complication of systemic absorption of TachoSil.

Comparison of Intraocular Pressure Measurement by Goldmann Applanation Tonometer, Air Puff Tonometer and Tonopen in Vitrectomized Eyes

Objective: To compare Goldmann applanation tonometer, air puff tonometer, and tonopen measured IOP Readings in vitrectomized eyes filled with temponading oils and gasses. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi Pakistan, from Aug 2021 to Feb2022. Methodology: A total of 50 eyes were included in our study. Intraocular pressure was measured by an experienced ophthalmologist between 10am to 4pm on the 7th postoperative day by three devices, Goldmann applanation tonometer (GAT), air puff tonometer, and tonopen. Pearson’s correlation and paired samples t-test was applied to determine correlation and any significant difference between the mean of intraocular pressure measured by three different devices. Results: Out of the 50 people included in study 31(62%) were males and 19(38%) were females. The mean age of study participants was 50.10±11.61 years. Mean intraocular (IOP) pressure measured by the GAT applanation tonometer was 14.59±1.13 mmHg. Mean IOP as calculated by the airpuff tonometer was 15.93±1.88 mmHg, whereas mean IOP as calculated by tonopen was 15.85±1.86 mmHg. All three instrument values showed significant difference as p-value &lt; 0.001. Conclusions: The air puff tonometer overestimates IOP as compared to GAT. Tonopen and air puff tonometer produce IOP measurements that are similar and consistent to each other but not to GAT

Atrioventricular conduction recovery immediately after the re-operation in a repaired CHD patient.

This is a case of a 2.7-year-old girl with trisomy 21 and double outlet right ventricle who underwent epicardial pacemaker system placement for a surgical atrioventricular block and achieved atrioventricular conduction recovery immediately after residual ventricular septal defect closure. Although ventricular pacing ratio was 100% before re-operation, it declined to approximately 25% on the 6th post-operative day and was <1% 3 years after re-operation.

Use of the LigaSure for Closing Peritoneal Defects in an Experimental Rat Model

Background: There has not been an absolute consensus over the routine closure of peritoneal defect (PD) during laparoscopic totally extraperitoneal inguinal hernia repair (TEP). Pretied sutures, endoscopic stapling, and suturing are surgical techniques for closing PDs. Moreover, we observed that we could close small PDs during the TEP procedure by sealing with the LigaSure (LS). Objectives: The present study aimed to evaluate the necessity of closure PDs under a polypropylene mesh and the early intraperitoneal inflammatory, fibrotic, and adhesional effects of sealing PDs with the LS in an experimental rat model. Methods: A total of 35 male rats were assigned to five groups. 1- Control group: mesh was not used, and the peritoneum was left open; 2- Mesh group; mesh was placed directly on the PD without repairing, and three peritoneal repairing methods; 3- Stapling group: PD was repaired with metal clips; 4- Suture group: PD was repaired with Vicryl sutures; and 5- LigaSure group: PD was closed with the LS. Rats were sacrificed on the postoperative 14th day. Adhesion scores, fibrosis, and inflammation scores were compared between all groups. Results: All rats completed the 14 days of follow-up without complication. The Mesh group had significantly higher adhesion scores than the other groups (P&lt;0.001). Nonetheless, no significant difference was observed between peritoneal repairing methods (P=0.696). Fibrosis and inflammatory scores were similar in peritoneal repairing methods (P=0.394 and P=0.112, respectively). Conclusion: The direct contact of foreign bodies with the intra-abdominal organs increases the risk of adhesion; therefore, the remaining PDs under the polypropylene mesh should be repaired. Sealing PDFs with LS is a simple method that does not increase the inflammatory response, fibrosis, and the risk of adhesion formation.

Intravenous lidocaine improves postoperative cognition in patients undergoing laparoscopic colorectal surgery: a randomized, double-blind, controlled study

BackgroundThe risk of postoperative cognitive dysfunction(POCD) in laparoscopic surgery should not be overlooked. Intravenous lidocaine can reduce perioperative inflammatory response in patients undergoing laparoscopic surgery, while the effect of intraoperative intravenous lidocaine on postoperative cognitive function in patients undergoing laparoscopic colorectal cancer surgery has not been well studied. We investigated whether intraoperative lidocaine improves postoperative cognitive function after laparoscopic radical resection for colorectal cancer.MethodsWe conducted a prospective, randomized double blinded controlled trial to investigate the effect of intravenous lidocaine on rapid postoperative recovery in patients undergoing laparoscopic radical resection of colorectal cancer. The patients were randomly assigned to receive either intravenous lidocaine or saline. The primary outcome was cognitive dysfunction defined by a decrease from pre- to postoperative ≥ 2 of the Mini-Mental State Examination (MMSE) score, at the 3rd and the 7th postoperative days. Secondary outcomes were the MMSE raw score and parameters of the patients’ postoperative recovery such as agitation and length of stay in the post-anaesthesia care unit (PACU), length of hospital stay, markers of inflammation (white blood cell count and CRP), and incidence of complications.ResultsSeventy-three patients in the lidocaine group and 77 patients in the control group completed the trial. The rate of cognitive dysfunction was lower in the lidocaine group than that in the control group, both at the 3rd (18.57% vs. 63.64% for each group respectively; RR = 0.26, 95%CI = 0.19–0.32; p < 0.0001) and at the 7th postoperative day (12.33% vs. 53.25% for each group respectively; RR = 0.28, 95%CI = 0.22–0.35; P < 0.001). The postoperative MMSE scores were also higher in the lidocaine group than in the control group both at the 3rd (median 25 vs. 24 respectively) and at the 7th postoperative day (26 vs. 24 respectively). Also, patients in the lidocaine group displayed a lower white blood cell count than the control group at the 1st postoperative day (8.5 ± 2.7 vs. 10.4 ± 3.3; p < 0. 001). No differences were evidenced for the other secondary outcomes.ConclusionsIntraoperative intravenous lidocaine can significantly improve postoperative cognitive function in patients undergoing laparoscopic radical resection of colorectal cancer.Trial registrationChinese Clinical Trial Registry (16/1/2022, registration number: ChiCTR2200055683)

The effect of an abdominal binder on postoperative outcome after open incisional hernia repair in sublay technique: a multicenter, randomized pilot trial (ABIHR-II)

IntroductionAlthough the evidence is minimal, an abdominal binder is commonly prescribed after open incisional hernia repair (IHR) to reduce pain. This study aimed to investigate this common postoperative treatment.MethodsThe ABIHR-II trial was a national prospective, randomized, multicenter non-AMG/MPG pilot study with two groups of patients (wearing an abdominal binder (AB) for 2 weeks during daytime vs. not wearing an AB following open IHR with the sublay technique). Patient enrollment took place from July 2020 to February 2022. The primary endpoint was pain at rest on the 14th postoperative day (POD) using the visual analog scale (VAS). The use of analgesics was not systematically recorded. Mixed-effects linear regression models were used.ResultsA total of 51 individuals were recruited (25 women, 26 men; mean age 61.4 years; mean body mass index 30.65 kg/m2). The per-protocol analysis included 40 cases (AB group, n = 21; No-AB group, n = 19). Neither group showed a significant difference in terms of pain at rest, limited mobility, general well-being, and seroma formation and rate. Patients among the AB group had a significantly lower rate of surgical site infection (SSI) on the 14th POD (AB group 4.8% (n = 1) vs. No-AB group 27.8% (n = 5), p = 0.004).ConclusionWearing an AB did not have an impact on pain and seroma formation rate but it may reduce the rate of postoperative SSI within the first 14 days after surgery. Further trials are mandatory to confirm these findings.

Effect of Platelet-Rich Fibrin on Soft Tissue, Periodontal Pocket Healing, and Alveolar Bone Height after Third Molar Surgery: A Randomized Clinical Trial

Background: More and more studies were being conducted to improve healing after third molar surgery. The aim of this study was to evaluate the effect of PRF on soft tissue and periodontal pocket healing, alveolar bone resorption distal to the second molar after lower third molar surgical removal. Methods: A Randomized, controlled clinical trial and split-mouth design was performed on 26 healthy patients who had an indication of impacted lower third molars extraction on both sides with symmetrical orientation and the same difficult index. All patients had the same extraction protocol on both sides at the Department of Oral Surgery, Faculty of Odonto-stomatology, University of Medicine and Pharmacy, Ho Chi Minh City. PRF was applied on one side, whereas the other was left empty as the control group. Assessing the soft tissue healing, periodontal pocket depth and distal bone resorption of the study and control groups after third molar removal surgery. Data obtained were statistically analyzed. Results: There is a statistically significant difference in soft tissue healing on the 3rd and 7th postoperative days and distal bone resorption (p&lt;0.05) on the 3rd and 6th postoperative months between two groups. Periodontal pocket depth of the study group showed more reduction than the control group but was not significantly different. Conclusion: Using PRF can help improve soft tissue healing and lower distal bone resorption after surgical extraction of impacted lower third molars. PRF appears to reduce periodontal pocket depth but still needs more research to conclude.

A delayed spontaneous second-trimester tubo-abdominal pregnancy diagnosed and managed by laparotomy in a “self-identified” infertile woman, a case report and literature review

BackgroundAbdominal pregnancy, a rare form of ectopic pregnancy, is associated with high morbidity and adverse consequences for future fertility. Early recognition and management reduce mortality and allow minimal invasive and conservative treatment. In modern medicine, primitive prevention to unexpected fatal pregnancies is crucial.Case presentationA divorced 33-year-old “self-identified” infertile polycystic ovary woman diagnosed as repeated implantation failure in previous in vitro fertilization with her ex-husband ever presented in surgery department with a history of 15-day abdominal pain, nausea, and vomiting and 3-h worsening abdominal pain. The serum beta-human chorionic gonadotropin value was more than 10,000 m-international units per milliliter. Sonogram findings were significant for the absence of intrauterine gestation; a placenta and well-formed living fetus of second-trimester gestation were seen in the abdomen, accompanied by hemoperitoneum. A unique spontaneously second-trimester tubo-abdominal pregnancy was confirmed in emergent laparotomy by gynecologists, she received a removing of the living fetus, a right total salpingectomy, resection of partial omentum and blood transfusion. The patient recovered uneventfully and her serum beta-human chorionic gonadotropin returned to normal range on the 30th postoperative day, till now, she has weak fertility awareness because of her catastrophic experiences in the unexpected abdominal pregnancy.ConclusionsThis case highlights woman with a previous in vitro fertilization history may be in is a high risk to be delayed or missed in diagnosis in an intended ectopic pregnancy due to a fixed belief in infertility. Educational interventions and contraceptive care should be provided by fertility and healthcare practitioner. The possibility of abdominal pregnancy must always be suspected and dealt with promptly and appropriately by the astute clinician.

Effect of Leukocyte- and Platelet-Rich Fibrin in Postoperative Recovery Following Impacted Mandibular Third Molar Surgery: A Split Mouth Study

Objective: The surgeries for extraction of impacted lower third molars are more associated with complications such as pain and postoperative edema. The purpose of the present study was to evaluate the impact of the use of Leukocyte- and Platelet-Rich Fibrin (L-PRF) on pain and edema after extraction of impacted mandibular third molars.&#x0D; Material and Methods: A cross-sectional split-mouth study was conducted with 15 volunteer patients who had both impacted mandibular third molars with indication for extraction. The removal surgery was performed one side at a time, with an interval of 14 days. One side received L-PRF while the other did not. Patients were evaluated on the 2nd and 7th postoperative days for mouth opening, pain and edema.&#x0D; Results: In total, data from 14 patients (4 men and 10 women), with a mean age of 21.83 ± 2.8 years were evaluated. There was no statistically significant difference regarding mouth opening, pain and edema on the 7th postoperative day. On the second postoperative day, greater edema was observed in the control group with a statistically significant difference (p = 0.01).&#x0D; Conclusions: Under controlled conditions, the L-PRF does not appear to alter postoperative recovery after extraction of the lower third molars in terms of pain, edema and the ability to open the mouth. Despite the statistically significant difference in edema on the second day, the means were very close and were not clinically relevant.