Surgical Approach For Management Research Articles

Minimally Invasive Approach in Surgical Management of Renal Neoplasms National Cancer Institute Experience

BACKGROUND: Minimally invasive nephrectomy is considered a technically challenging procedure requiring a long learning curve to reach acceptable warm ischemia time and perioperative complications. These minimally invasive techniques result in a shorter hospital stay and less post-operative pain.
 AIM: This study aims to demonstrate the National Cancer Institute experience regarding the benefits of laparoscopic and robot-assisted nephrectomy over open technique.
 METHODS: This is a retrospective descriptive cohort study including 62 patients with renal masses treated with nephrectomy whether partial, total or radical, 26 cases were treated by minimally invasive techniques (8 robotic and 18 laparoscopic), while 36 cases were treated by open technique. Inclusion criteria were patients between 20 and 70 years with renal neoplasm without renal vein thrombosis, with tumor stage T1 or T2 N0 M0. Exclusion criteria were patients with medical comorbidities that preclude surgical management or minimally invasive techniques and patients refusing surgery in general.
 RESULTS: Minimally invasive nephrectomy resulted in shorter hospital stay (mean hospital stay was 2.2 days for the minimally invasive group and 3.6 days for the open group) and less post-operative pain than open technique (p < 0.001 and = 0.002, respectively), while open technique resulted in shorter operation time (p = 0.039, mean operation time 147.8 min compared to 184.8 in the minimally invasive group).
 CONCLUSION: Minimally invasive nephrectomy (laparoscopic and robotic) resulted in less post-operative pain and shorter hospital stay compared to open technique despite consuming longer operation time which may be decreased by improving the learning curve of operating surgeons.

Minimally Invasive Surgical Approaches for Broad Ligament Fibroids

Study Objective Demonstration of different minimally invasive surgical approaches for broad ligament myoma Design N/A Setting University teaching hospital. Patients or Participants N/A Interventions Minimally invasive surgical approach was tailored according to the anatomical location of the fibroid, and the patients’ fertility desires. Measurements and Main Results N/A Conclusion Broad ligament myomas present a challenging situation to surgeons. Surgeons should tailor their approach according to the anatomical location of the myomas. MIS is a feasible and safe approach for surgical management of broad ligament myomas.

Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures.

A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures. To evaluate and compare the primary functional outcome using the Helkimo's dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches. In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association. Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group. Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.

Guideline No. 404: Initial Investigation and Management of Benign Ovarian Masses.

To provide recommendations for a systematic approach to the initial investigation and management of a benign ovarian mass and facilitate patient referral to a gynaecologic oncologist for management. Obstetricians, gynaecologists, family physicians, internists, nurse practitioners, radiologists, general surgeons, medical students, medical residents, fellows, and other health care providers. Women ≥18 years of age presenting for evaluation of an ovarian mass (including simple and unilocular cystic masses, endometriomas, dermoids, fibromas, and hemorrhagic cysts) who are not acutely symptomatic and without known genetic predisposition to ovarian cancer. This guideline aims to encourage conservative management and help reduce unnecessary surgery and long-term health complications, maintain fertility, and decrease operative costs and improve overall patient care and outcomes by providing criteria for referral of patients with ultrasound imaging findings suggestive of a malignant mass to a gynaecologic oncologist. Databases searched: Medline, Cochrane, and PubMed. Medical terms used: benign asymptomatic and symptomatic ovarian cysts, adnexal masses, oophorectomy, ultrasound diagnosis of cysts, simple ultrasound rules, surgical and medical therapies for cysts, screening for ovarian cancer, ovarian torsion, and menopause. Initial search was completed by 2017 and updated in 2018. Exclusion criteria were malignant ovarian cystic masses, endometriosis therapies, and other adnexal pathologies unrelated to the ovary. The content and recommendations were drafted and agreed upon by the authors. The Society of Obstetricians and Gynaecologists of Canada's Board of Directors approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework. Implementation of the recommendations could reduce costs due to unnecessary surgeries and hospitalizations and reduce lost work days and the risk of loss of fertility, early menopause, and surgical complications. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Hepatic separation of conjoined twins: Operative technique and review of three-dimensional model utilization

BackgroundThe separation of conjoined twins is a challenging and rare operation. Recent technological advances in imaging and three-dimensional printing (3DP) have allowed for enhancements in preoperative surgical planning and intraoperative anatomical orientation for complex operations. This report aims to consolidate the current clinical evidence utilizing 3DP models as an effective tool for surgical planning of conjoined twin separation and to detail our surgical approach for complex hepatic separation and management. MethodsA literature review was conducted for conjoined twin separations with preoperative use of 3D models including age at attempted separation, operative outcome, 3D modality, and postoperative course between 1998 and 2020. We also conducted a chart review of our electronic medical record for conjoined twin separations between January 2015 and December 2019. ResultsWe report two cases of conjoined twin separation with preoperative use of 3DP models from our institution: one set in the thoracoomphaloischiopagus orientation and the other set in the thoracoomphalopagus orientation with the presence of intrahepatic vascular anomalies. The literature review produced 10 case reports of conjoined twin separation with use preoperative 3D models accounting for 17 individual separation procedures. We summarize our preoperative radiological planning, the evidence of 3DP models as an educational and preoperative tool, ideal timing for separation, and our surgical approach for complex hepatic separation. ConclusionsConjoined twin separation requires a multidisciplinary effort to address the multisystem surgical and medical needs of these patients. These complex patients require extensive preoperative imaging for planning separation, and we strongly recommend utilizing 3D printed models when possible for better surgeon understanding of complex variable anatomy. We have found numerous reports of successful conjoined twin separation using 3DP technology in preoperative planning. The use of three-dimensional printed models for preoperative assessments is an invaluable tool and is rapidly improving in fidelity. Type of studyOperative technique and case series. Level of evidenceLevel IV.

Nasal reconstructive surgery for vasculitis affecting the nose: our two-centre international experience.

To recommend an international multidisciplinary medical and surgical algorithm of treatment in nasal vasculitis, which will create a more streamlined approach. A two-centre, international retrospective analysis of granulomatosis with polyangiitis (GPA) and levamisole-associated vasculitis (LAV) cases presenting between 2005 and 2019 was carried out. Demographic data, and surgical and medical treatment were recorded. Patients' signs and symptoms were analysed, and recommended treatment strategies outlined with key surgical procedures described. Forty-one GPA patients and 11 LAV patients were included in the study with a mean age of 38.6 and 38.8years, respectively. A stepwise surgical management approach with reconstructive options is described and includes: (1) examination under general anaesthesia, biopsy, and insertion of silastic nasal splints; (2) septal perforation repair (with caution); (3) mild-to-moderate saddle nose reconstruction with costal cartilage; (4) severe saddle nose reconstruction with osseocartilaginous rib grafts; (5) soft-tissue reconstruction techniques. The management of nasal vasculitis is a particular challenge in facial plastic surgery. It requires a close collaborative approach with a physician skilled in the medical management of vasculitis. Surgery must be planned judiciously, with realistic patient expectations and only after a sustained period of remission. For more severe saddle deformities, the modified osseocartilaginous Andrews technique gives excellent long-term results.

Prosthetic Management of Post-surgical defect in the Mandible following Marsupialization: A Case Report

Marsupialization is a conservative surgical approach for the surgical management of large odontogenic lesions. Such procedure often results in a post-surgical defect in the form of an intraoral opening. The patency of such defect, if not maintained can result in food accumulation which may lead to infection and thus delayed healing of the defect. Obturator is one of the modalities to facilitate closure of the resultant defect. This report presents a case where an acrylic plug obturator retained with clasp, was provided to the patient for the interim period following marsupialization on the mandibular left posterior region.

No need to watch the clock: persistence during laparoscopic sigmoidectomy for diverticular disease.

Laparoscopic sigmoidectomy is the preferred approach in the elective surgical management of diverticulitis. However, it is unclear if the benefits of laparoscopy persist when operative times are prolonged. We aimed to investigate if the recovery benefits associated with laparoscopy are retained when operative times are long. A retrospective review of a prospectively maintained database of patients who underwent elective laparoscopic sigmoidectomy from 2010-2015 at a single academic tertiary institution was performed. Operative times among laparoscopic completed cases were divided into quartiles, and patient outcomes were compared between the groups. A total of 466 patients (median age: 58 ± 11.6years, 58% females) underwent sigmoidectomy: 430 completed laparoscopically and 36 (7.7%) converted. Median operative time in laparoscopically completed cases was 188min (IQR 154-230). There were no differences in morbidity (P = 0.52) or readmission rates (P = 0.22) among the quartiles. The 2nd and 4th operative time quartiles were associated with significantly longer length of stay (LOS) when compared to the fastest quartile (P = 0.003 and P = 0.002, respectively), but there was no increase in LOS as operative times progressed between the 2nd, 3rd, and 4th quartiles. LOS after conversion was longer but did not reach statistical significance when compared to laparoscopically completed operations in the longest quartile (5.0 vs 6.5days, P = 0.075) CONCLUSIONS: Our data do not support preemptive conversion of laparoscopic sigmoidectomy to avoid prolonged operative times. As long as progress is safely being made, surgeons are justified to continue pursuing laparoscopic completion.

Posterior to anterior malleolar extended lateral approach to the ankle (PAMELA): a cadaveric anatomic study.

The posterolateral approach is used in most cases of surgical treatment of ankle fractures involving the posterior and lateral malleoli. However, this approach does not allow access to the anterolateral structures of the ankle, which represent important landmarks to allow an anatomical reduction in case of complex ankle fracture. Our objective is to propose a novel surgical approach for optimal management of injuries including both a fracture of the posterior malleolus and a complex lesion of the lateral and/or anterolateral portions of the ankle. Cadaveric dissection, including a vascular study, was performed on eight specimens. Assessment included density of the vascular supply around the lateral malleolus, identification of the structures at risk, quality of exposure of the bony structures, and convenience of hardware fixation. The cutaneous flap benefits from a rich interconnected arterial supply. Structures at risk, including the superficial peroneal and sural nerves, the lesser saphenous vein, and the peroneal artery are easily identified and protected. The interval between the peroneal tendons and the flexor hallucis longus muscle provides optimal access to the posterior malleolus. The lateral malleolus is exposed by retracting the peroneal tendons medially. An anterolateral arthrotomy, respecting the anterior talofibular and tibiofibular ligaments, offers a sharp view on the talo-tibio-fibular junction. Hardware placement can be done with optimal access to any exposed surfaces. The PAMELA opens a new perspective in the optimal management of complex fractures of the ankle. The approach allows optimal exposure to address fractures of the posterior malleolus, of the lateral malleolus, and of the anterolateral portion of the ankle through a single incision. Application in clinical practice is the subject of a future study in our institution.

Terrorist attacks: common injuries and initial surgical management.

Terrorism-related incidents and shootings that involve the use of war weapons and explosives are associated with gunshot and blast injuries. Despite the perceived threat of terrorism, these incidents and injuries are rare in Germany. For this reason, healthcare providers are unlikely to have a full understanding of the special aspects of managing these types of injuries. Until a clear and complete picture of the situation is available after a terrorist or shooter incident, tactical and strategic approaches to the clinical management of the injured must be tailored to circumstances that have the potential to overwhelm resources temporarily. Hospitals providing initial care must be aware that the first patients who are taken to medical facilities will present with uncontrollable bleeding from injuries to the trunk and body cavities. To improve the outcome of these patients in extremis, the aim of the index surgery is to stop the bleeding and control the contamination. Unlike damage control surgery, which is tailored to the patient's condition, tactical abbreviated surgical care (TASC) is first and foremost adapted to the overall situation. Once the patients are stabilised and all information on the situation is available, the surgical management and reconstruction of gunshot and blast injuries can follow the principles of damage control (DC) and definitive early total care (ETC). The purpose of this article is to provide an overview of the pathophysiology of gunshot and blast injuries, wound ballistics, and the approach and procedures of successful surgical management.

Lung cancer staging: State of the art in the era of ablative therapies and surgical segmentectomy.

Implementation of lung cancer screening and improvements in imaging are expected to increase the proportion of lung cancer diagnosed at an early stage. The standard of care has historically been anatomic lobectomy; however, there is now an array of surgical and non-surgical approaches for management of local disease either in active use or under investigation. By their nature, these new modalities offer a theoretical trade-off of reduced morbidity in exchange for reduced efficacy in the setting of advanced disease. It is therefore critical that patients being considered for these approaches (e.g. surgical segmentectomy and SABR) be accurately staged to maximize the potential for definitive treatment. In this article, we will review current approaches to the staging of patients being considered for segmentectomy or ablation. This will serve as a foundation to highlight important questions deserving further investigation.

A modification of ward's incision for management of mandibular angle fracture

It is a well-known fact that mandibular angle fracture is one of the most frequently encountered fractures in the facial skeleton. Lot of emphasis is given to the kind of fixation devices as well as number of fixation devices used in the management of these fractures. However, it is noteworthy that some of the distinguished complications are associated with the flap design and soft-tissue handling. This short communication highlights the fact that the Ward's incision without the distal release is a very valuable surgical approach in the management of these fractures.

MP68-06 FACTORS AFFECTING ROBOTIC CONVERTED TO RADICAL NEPHRECTOMY

INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy (RPN) has become a common approach for surgical management of T1a renal masses. Previous studies are primarily from tertiary referral centers. We sought to identify factors affecting conversion of robotic in a multi-institutional setting and to assess if patients with masses amenable to RPN would have a change in outcome compared to tertiary referral centers. METHODS: We retrospectively identified 324 patients who underwent attempted RPN between 2016 – 2019 at multiple centers, all of which are part of the MUSIC database. Patient characteristics such as body mass index (BMI), Charlson comorbidity index, age, pre-operative creatinine, and presence of chronic kidney disease (CKD) were collected. Data regarding the tumor, such as R.E.N.A.L. score, tumor size, and final pathology results were also examined. These data and perioperative outcome were then compared between converted and non-converted cases. RESULTS: The overall conversion rate was 4.6% (15 of 324 cases). Patient age, BMI, Charlson comorbidity index, pre-operative creatinine, and presence of chronic kidney disease did not significantly impact the rate of conversion. Tumor location was the main reason for conversion, accounting for 11/15 (73.3%) of conversions. Difficult dissection, blood loss, and tumor invading critical structures were also reasons for conversion. Increasing tumor size (4.6 vs 2.7cm, p <0.01) was an independent factor for conversion. R.E.N.A.L. score was reported in 75 cases. In reported cases, increasing R.E.N.A.L score was associated with increased rate of conversion. Converted cases final pathology revealed fat invasion 33% (5/15), Gerota fascia invasion 6.7% (1/15), renal vein invasion 13.3% (2/15), and direct extension to adrenal 6.7% (1/15). CONCLUSIONS: In a multi-institutional setting, the rate of robotic partial converted to radical nephrectomy was 4.6%. This is consistent with the average rate of conversion at tertiary referral centers in previously reported literature. In our study, increasing tumor size and tumor complexity using R.E.N.A.L. score were the main predictors of conversion. Source of Funding: Blue Cross Blue Shield of Michigan

Time trend analysis of thyroid cancer surgery in China: single institutional database analysis of 15,000 patients

PurposeThe institutional database of the Thyroid Surgery Division in China–Japan Union Hospital of Jilin University was queried to audit time trend patterns in thyroid cancer (TC) management between 2008 and 2017.MethodsRetrospective longitudinal analysis. Clinicopathological features and treatment strategies were analyzed. Frequencies and multivariate tests were used to detect correlations.ResultsClinical data were obtained from 15,000 TC patients (i.e., 71.3% of 21,044 operations). Papillary was the most common histological subtype (n = 14,916, 99%), and 76% were microcarcinomas. Stage I (95%) and low-risk patients (58%) were prevalent throughout the 10-year period. The trend for total thyroidectomy increased from 29.1% (2008–2012) to 67.9% (2013–2015), and then dropped to 48.6% (2016–2017). A total of 8827 (52%) patients received central lymph node dissection (CLND). The tendency for CLND increased from 15.7 to 86.4% during the 10-year period. While the trend of lateral lymph node dissection decreased from 71.3 to 13.3%. Radioactive iodine therapy was offered to 10% of patients (2008–2012), except for a low value (5.4%) in 2009, and then increased from 12.3% (2012) to 41.3% (2015), while decreased to 32.4% (2017).ConclusionThe surgical management of TC patients has undergone continuous changes over the past 10 years. The evolution from aggressive treatment to a more conservative approach has been constant. Our results suggest that the current surgical management approach for TC is adequate and in support of the published guidelines. Our findings warrant further investigation to determine the clinical implications of decision making for TC.

Predictive Factors of Difficulty of Laparoscopic Management of Cancer Rectum

Abstract Background rectal cancers compromise approximately 25% of all primary colorectal cancers and follow a different natural disease course compared to colonic tumours, also it is well established that surgical approach, local recurrence rates and associated complications of rectal tumours are distinct from colonic ones. Purpose to use the previously mentioned factors that can influence the difficulty of performing laparoscopic anterior resection. And by using standardized operative time as an end point build reliable study models thys predicting operative difficulty for clinical use. Patients and Methods this is a prospective case series descriptive study analyzing the predictive factors of laparoscopic approach in surgical management of rectal carcinoma. Clinical records of listed patients that underwent laparoscopic anterior resection at Ain Shams University Hospitals were reviewed. Clinical records of listed patients that underwent laparoscopic anterior resection at Ain Shams University Hospitals from March 2018 to September 2018 were reviewed. Results some factors collected from the patients data as high BMI, old age, intraoperative blood loss and tumor staging may predict the difficulty of laparoscopic intervention for cancer rectum. Conclusion laparoscopic resection for low rectal cancers is a feasible technique and with proper training it can be performed safely with acceptable rates of overall morbidity and by taking into consideration the above mentioned factors that may predict the difficulty of Laparoscopic intervention in order to have the best outcome from the decision of Laparoscopic anterior resection for patients with cancer rectum.

Prognostic Factors of Anterior Surgical Approach in Management of Cervical Spondylotic Myelopathy

Background: Spondylotic cervical myelopathy is defined as spinal cord dysfunction secondary to extrinsic compression of the spinal cord and/or its vascular supply so it is the commonest cause of cord dysfunction in patients over 55 years. Main Surgery target is to prevent the progression of symptoms also to improve existing symptoms.Aim of the work: To determine prognostic factors of patients with spondylotic cervical myelopathy that surgically managed through anterior approach in relation to outcome clinically and radiologically.Patients and methods: From July 2015 till December 2018, forty patients with cervical myelopathy were operated by anterior surgical approach (anterior cervical discectomy with fusion and/or corpectomy with fusion. Only patients with confirmed spondylotic myelopathy were included; we exclude those with an infectious, inflammatory or neoplastic etiology.Results: Patients ages were ranged from (40-67) years, with a mean age 53.2 years. Duration of myelopathy ranged from 2-18 months with a mean duration of 8.55 months. 72.5% patients were treated by discectomy with fusion and 27.5%cases were treated by combined discectomy and corpectomy with fusion. Excellent outcome was reported in 22.5%, while 62.5% cases had good outcome,15% patients had fair outcome. Patient age, disease severity, duration, bowel & bladder manifestations and affection of dorsa column were the prognostic factors in studied patients. Conclusion: Our study reveals that the significant prognostic factors are: age of patient, severity of myelopathy, duration of myelopathy, presence of bowel or bladder symptoms, dorsal column affection and high signal intensity of T2 weighted MRI.

Current state of the art imaging approaches for colorectal liver metastasis.

One of the most common cancers worldwide, colorectal cancer (CRC) has been associated with significant morbidity and mortality and therefore represents an enormous burden to the health care system. Recent advances in CRC treatments have provided patients with primary and metastatic CRC a better long-term prognosis. The presence of synchronous or metachronous metastasis has been associated, however, with worse survival. The most common site of metastatic disease is the liver. A variety of treatment modalities aimed at targeting colorectal liver metastases (CRLM) has been demonstrated to improve the prognosis of these patients. Loco-regional approaches such as surgical resection and tumor ablation (operative and percutaneous) can provide patients with a chance at long-term disease control and even cure in select populations. Patient selection is important in defining the most suitable treatment option for CRLM in order to provide the best possible survival benefit while avoiding unnecessary interventions and adverse events. Medical imaging plays a crucial role in evaluating the characteristics of CRLMs and disease resectability. Size of tumors, proximity to adjacent anatomical structures, and volume of the unaffected liver are among the most important imaging parameters to determine the suitability of patients for surgical management or other appropriate treatment approaches. We herein provide a comprehensive overview of current-state-of-the-art imaging in the management of CRLM, including staging, treatment planning, response and survival assessment, and post-treatment surveillance. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are two most commonly used techniques, which can be used solely or in combination with functional imaging modalities such as positron emission tomography (PET) and diffusion weighted imaging (DWI). Providing up-to-date evidence on advantages and disadvantages of imaging modalities and tumor assessment criteria, the current review offers a practice guide to assist providers in choosing the most suitable imaging approach for patients with CRLM.

Review and Analysis of Research Trends in Surgical Treatment of Pediatric Chronic Sinusitis.

Background Chronic sinusitis is a common otolaryngologic complaint with a significant impact on patients’ quality of life. There is current debate and differences in quality of evidence regarding the best surgical management approach to pediatric chronic sinusitis. Objective To investigate changes in publishing trends over time in surgical management of pediatric chronic sinusitis. Methods A systematic literature review was conducted in January 2019 using Embase, PubMed, and Web of Science, of all articles that included surgical treatments for pediatric chronic sinusitis. Publications were grouped into 3 time periods: pre-1998, 1999–2008, and 2009–2018. In addition, a subgroup of publications pertaining to endoscopic sinus surgery, balloon sinuplasty, and adenoidectomy were grouped into 2-year periods since 1988 to compare the number of publications on each topic and to examine overall trends. Results A total of 327 abstracts were included in the data collection and analysis. There was an overall significant increase in total number of publications ( P &lt; .0001), total number of authors ( P = .001), and comparison studies ( P = .003) from pre-1989 to 2018. Relative number of prospective studies, systemic review, and case studies/expert opinions have not significantly increased over time when comparing decades ( P &gt; .05). Among the surgery types, functional endoscopic sinus surgery has the most amount of publications regardless of year despite a statistically significant increase in publications pertaining to balloon sinuplasty in the pediatric literature from 1999–2008 to 2009–2018 ( P = .001). Conclusions Studies on pediatric chronic sinusitis have increased significantly during each of the last 2 decades with an increase in the concomitant number of authors and comparison studies. Although most publications are still Level C or D evidence, there has been a nonsignificant increase in Level A evidence in the past decade. Endoscopic sinus surgery still remains the most studied procedure despite the recent increase in publications on balloon sinuplasty.

Cervical Oesophagotomy and Removal of an Impacted Oesophageal Denture: Case Report and Literature Review

We present the case of a 46-year old man with a two-year history of losing his denture presenting with cachexia and a two-month history of dysphagia to both liquids and solids associated with odynophagia. Review at the ENT department where a diagnostic rigid oesophagoscopy was done under general anaesthesia showed a denture impacted to the wall of the oesophagus at 17 cm from the incisor. Attempts at retrieval were unsuccessful as the denture was deeply embedded in the oesophageal wall and bled easily on attempted removal. He subsequently underwent a 2-stage surgical management approach by the cardiothoracic surgical team. Patient first underwent nutritional rehabilitation for a month through a created feeding gastrostomy tube via a limited midline laparotomy. He then had a open cervical oesophagotomy and removal of the denture. Currently doing well six months after surgery and tolerating normal oral diet.

A Promising and Challenging Non-Invasive Solution to the Troubling Stress Urinary Incontinence: Bladder Neck Injection with Bulking Agents

Endoscopic surgical approaches for management of sinonasal diseases have become a widely spread intervention surgery however a trivial bleeding amount could greatly affect the visibility during..