Average Duration Of Surgery Research Articles

Использование биометрических параметров верхних мочевых путей для планирования оперативных методов лечения нефролитиаза.

Introduction. The prevalence of urolithiasis (ICD) reaches 5-20% with an annual increase. Endoscopic methods play a leading role in the surgical treatment of urolithiasis. The aim of the surgery is the achievement of stone free status without complications. The technological progress has led to the development of computer programs for visualization before the surgery, which have been used to assess the topography, skeletotopy, anatomy of the renal cavity system, structural features and angioarchitectonics. Aim of the study. Improving the effectiveness and safety of percutaneous interventions using the biometric planning method. Materials and methods. We analyzed the treatment results of 120 patients who were underwent percutaneous interventions for nephrolithiasis in the period from 2019 to 2021. The main method of preoperative examination was multispiral computer tomography (MSCT) with 3D reconstruction and biometric assessment of anatomical parameters. Results. Single kidney stones were detected in 45 patients, multiple – in 24, coral-shaped – in 51 patients. The growth of microflora in urine culture was noted in 64 cases. The average time of X-ray screening was 20.5 minutes (7-34 minutes). The average duration of surgery is 110 minutes (65-240 minutes). Complete purification of the calyx-pelvic system from concretions was achieved in 78% of patients. Complications were detected in 21 (17.5%) patients, 52% of them – grade I-II on the Clavien-Dindo scale. The optimal parameters for percutaneous nephrolithotripsy in monotherapy mode were determined: lower polar anatomy – neck length < 2 cm, width > 0,5 cm, lower cervical-pelvic angle > 70°, lower cervical-frontal angle >135°; upper polar anatomy – single calyx, calyx neck length < 2 cm, width calyx necks > 1,0 cm, upper cervical-cervical angle > 135°, upper cervical-frontal angle >135°; anatomy of the central segment – A1. Discussion. The creation of a morphometric model makes it possible to define the stages of surgery, reduce the risks of complications, increase the efficiency and safety of the procedure. Conclusion. Currently the use of biometric parameters before percutaneous and endoscopic intrarenal interventions is the most effective method of virtual planning, which allows to free the urinary tract from the maximum volume of stone and return the patient to a full life in the shortest possible time.

Endoscopic intradural extramedullary lesion excision: Results of augmented duroplasty with artificial dura.

Prevailing techniques of dural closure in endoscopic spine surgery (ESS) for intradural extramedullary (IDEM) tumor excision increase the steep learning curve and operative time. We aimed to assess the efficacy of augmented duroplasty with artificial dura and share our initial experience of ESS for IDEM excision. We retrospectively analyzed 18 (n = 18) consecutive patients of IDEM tumors operated by ESS using Destandau's endoscopic system. The pre-operative, post-operative, and at the latest follow-up clinical status were recorded in terms of Nurick's grades and the Oswestry Disability Index. Immediate post-operative complications and intraoperative findings were noted from hospital information system and patient records. The mean (± SD) age of patients was 40.3 ± 14.9 (range 19-64) years, with M: F ratio of 2:1. All the lesions were intradural and present at lumber (n = 6), thoracic (n = 9), and cervical (n = 3) regions. The average duration of surgery, blood loss, hospital stay, and duration of follow-up were 157 ± 45.3 (90-240) min, 168.8 ± 78.8 (30-300) mL, 4.29 ± 1.4 (2-7) days, and 19.3 ± 7.2 (7-36) months, respectively. There were no CSF leaks, wound-related complications, or material-induced adverse events. In endoscopic IDEM excision, dural closure with artificial dura is efficient in preventing CSF leak. It shortens the steep learning curve and improves the surgical outcome due to technical ease.

Minimally invasive surgery for hepatocellular carcinoma

Aim. To evaluate outcomes of laparoscopic liver resections in patients with hepatocellular carcinoma (HCC).Materials and methods. 40 endovideosurgical liver resections were performed in patients with HCC in the period of 2011–2021. Concomitant cirrhosis was detected in 36 cases (90%).Results. The average duration of surgery was 158.1 ± 78.6 min. The duration of anatomical lobar resections appeared to be the longest – 230 min. The average volume of intraoperative blood loss was 259.5 ± 260.5 ml, which almost excluded blood transfusions. The duration of hospitalization comprised 11.2 ± 2.3 days. One-year survival was achieved in 95% of cases, two-year – in 81%, three-year – in 64%.Conclusion. Laparoscopic liver resections in hepatocellular carcinoma prove to be safe and provide satisfactory surgical and oncological outcomes.

Surgical Outcome of Modified Karydakis Flap and Modified Limberg Flab in the Management of Sacroccygeal Pilonidal Disease: A Comparative Study

Abstract Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.

PRESSURE ULCERS INCIDENCE IN A PERIOPERATIVE NEUROSURGICAL SETTING

Background. Pressure ulcer is a major burden in surgical patients, increasing the length of hospital stay and the healing process, possibly leading to infectious complications and higher health care costs. In current literature there is no consensus on which element is mainly responsible for the onset of these lesions neither the role of surgery has been clarified. Methods. We collected a case series of consecutive admitted patients to Cattinara Hospital Neurosurgery Department in Trieste from March 2019 to June 2019. All the patients were assessed for surgery related pressure ulcer (SRPU) risk using the Pressure Score Risk Assessment Scale modified by Scotts. Epidemiologic data of all patients were recorded and the incidence of surgical related pressure ulcer calculated. The sample consisted of 124 patients with an average hospitalization length of 12.45 days; 71.8% of the enrolled patients were elective surgery patients, 5.5% emergency surgery and 22.6% urgency surgery. Comorbidity data were collected for each patient and surgical related time procedures noted. Results. The calculated incidence rate of surgery related pressure ulcer in a single center perioperative neurosurgical setting was 4.8%; the average surgery duration time was 213 minutes (mean ± 81 standard deviation, SD) whilst four out of six of these patients were admitted to intensive care unit due to unstable clinical conditions (average ICU stay time: 2.83 days; mean ± 4.99 standard deviation, SD). Time to SRPU onset was 6.83 days (mean ± 3.66 standard deviation, SD). The main site of SRPU onset was sacrum (66% of patients with developed SRPU). Discussion. This study evaluates single-center incidence of SRPU in neurosurgical perioperative setting with specifically SRPU management trained healthcare providers; deeper and systematic understanding of SRPU epidemiology in other local hospital wards and multi-centered comparison are needed.

Intravenous Propofol as An Adjunct to Spinal Anesthesia to Provide Sedation- A Clinico- Epidemiological Study

Background: Regional anesthesia is becoming an increasingly important aspect of anesthetic practice. Propofol offers titratable sedation and rapid recovery compromising hemodynamic stability. This may prove to be an important clinical consideration for its use as an adjunct to spinal anesthesia. So, this study investigated the properties of propofol when given by intravenous infusion to provide sedation as an adjunct to spinal anesthesia. Material and Methods: A prospective, clinical study was conducted among patients aged 18-40 years for elective surgery under spinal anesthesia. A total of 60 pregnant patients undergoing a C-Section with spinal anesthesia were randomly allocated into two groups. Patients in Group P (received a propofol infusion at a rate of 50 μg/kg/min), Inj. Hyperbaric Bupivacaine 0.5%, 2.5 cc (12.5 mg) intrathecally, and Group C (received 100 ml of isotonic solution), Inj. Hyperbaric Bupivacaine 0.5%, 2.5 cc (12.5mg) intrathecally. The level of sedation was recorded every 5 minutes (Level 4 or 5) on a 5-point sedation score. Results: The mean age group P was 27.2+/- 6.6 years and group C was 30+/-7.3 years. The average duration of surgery was 60± 12.7 minutes, the anesthetic time for group P was 68.8 ± 2.7 and for the group, C was 68.0 ± 6.5 and statistically significant (p<0.05). Recovery was impressively rapid and patients regained full consciousness approximately 7.8 ± 2.4 in group P after the end of infusion and were free from minor postoperative sequelae than group C. Conclusion: It has been concluded that intravenous propofol sedation as an adjunct to spinal anesthesia is associated with a lower incidence of postoperative complications & better compliance. Our findings should be confirmed in future prospective studies and more research trials are needed to find optimized doses for different ages, gender, and health status. The development of new modes of administration is a matter of interest and improved quality of sedation is much needed of the hour.

Experience with the use of Reverdin needle in neonatal thoracoscopic congenital diaphragmatic hernia repair

Background: Congenital diaphragmatic hernia is the total or partial absence of the diaphragm, which can be unilateral or bilateral. Becmeur et al. in 2001 mentioned the thoracoscopic management approach for the first time. Methods: The medical record of neonatal CDH thoracoscopic management (using the Reverdin Needle) from January to May 2021 at Dr. Roberto Gilberto Elizalde Children's Hospital located in Guayaquil, Ecuador was retrieved. Various parameters and characteristics were studied. Results: Four patients were included in this study. M:F ratio was 3:1 with all having a type B left sided defect. The average duration of surgery was 157.5 minutes and 2 of them developed pulmonary hypertension in post-op period. All had good outcomes. Conclusion: We propose that the possibility of a successful thoracoscopic surgery in congenital diaphragmatic hernia is increased with use of the Reverdin needle.

Energy Devices for Clipless-Sutureless Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis on Utility and Safety.

Background and Objectives: While laparoscopic appendectomy is standardized, techniques for appendiceal stump closure and mesoappendix division remain variable. Novel vessel sealing techniques are increasingly utilized ubiquitously. We sought to systematically summarize all relevant data and to define the current evidence on the safety and utility of energy devices for clipless-sutureless laparoscopic appendectomy in this systematic review and meta-analysis. Materials and Methods: This review was conducted following the PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were systematically searched. Inclusion criteria included studies with laparoscopic appendectomy for appendicitis. The intervention included patients undergoing division of mesoappendix and/or securing of the appendicular base using diathermy (Monopolar or Bipolar or LigaSure Sealing Device) or Harmonic Scalpel (Group A) compared to patients undergoing division of mesoappendix and/or securing of the appendicular base using endoclip or Hem-o-lok or ligature (Group B). The methodological quality of the included studies was assessed using the Downs and Black scale. The outcomes of surgical site infection (SSI) or intra-abdominal collection, postoperative ileus, average operative duration, and length of hospital stay (LHS) were compared. Results: Six comparative studies were included; three were retrospective, two were prospective, and one was ambispective. Meta-analysis revealed a shorter operative duration in Group A with respect to appendicular base ligation (MD -12.34, 95% CI -16.57 to -8.11, p < 0.00001) and mesoappendix division (MD -8.06, 95% CI -14.03 to -2.09, p = 0.008). The pooled risk ratios showed no difference in SSI between groups. Additionally, no difference was observed in LHS. The risk of postoperative ileus was higher in group B regarding mesoappendix division (RR 0.56, 95% CI 0.34 to 0.93, p = 0.02), but no difference was found concerning appendicular base ligation. The included studies showed a moderate-to-high risk of bias. Conclusions: Clipless-sutureless laparoscopic appendectomy is safe and fast. Postoperative ileus seems less common with energy devices for mesoappendix division. However, the studies included have a moderate-to-high risk of bias. Further studies addressing the individual devices with surgeons of similar levels are needed.

Clinical experience of minimally invasive duodenum preserving pancreatic head resection

BackgroundIn recent years, an increasing number of pancreatic surgeons has begun to pay attention to duodenum-preserving pancreatic head resection (DPPHR). The purpose of this article is to summarize our experience in minimally invasive DPPHR. MethodsWe retrospectively collected outcome data of twenty consecutive cases of laparoscopic or robotic DPPHR performed between June 2021 and January 2022 in the Fudan University Shanghai Cancer Center. ResultsAll patients successfully completed the operation under minimally invasive procedures, and in no case conversion to laparotomy or pancreaticoduodenectomy was required. The average operation duration was 293 ​± ​41 ​min (range: 216–393 ​min); the intraoperative blood loss was 163 ​± ​70 ​ml (range: 50–300 ​ml), and no intraoperative blood transfusion was required. A total of ten patients (50%) developed postoperative complications, including one patient who suffered a Clavien-Dindo complication grade ​≥ ​III. The average postoperative length of stay was 16.6 ​± ​5.4 days (range:10–33 days). ConclusionsMinimally invasive DPPHR for benign or low-grade malignant tumors of the head of the pancreas is a safe and effective operation, which can improve the long-term quality of life of patients, and is worthy of clinical application.

Evaluation of Perioperative and Quality of Life Outcomes Along with Cost Effectiveness in Laparoscopic Transabdominal Retrorectus Mesh Repair for Ventral Hernia: A Prospective Observational Study

Introduction: Laparoscopic ventral hernia repair has its advantages of reduced postoperative complication and early return to work. Owing to the need of a cost-effective technique with similar perioperative outcomes, transabdominal retro-rectus mesh repair (TARM) is a suitable and less expensive alternative compared with other methods of laparoscopic ventral hernia repair. Methods: Patients with primary (n = 7) or incisional (n = 17) hernia were selected to be operated on using TARM procedure. Quality of life was evaluated in terms of time to return to usual routine work, the sensation of mesh (using Carolinas Comfort Scale, CCS), tolerance to early oral feed, formation of seroma, suture site infection and hernia recurrence. Results: The average defect size was 2.8 cm with a mean BMI was 28.17 kg/m2. The average duration of surgery was 165 mins. Mean postoperative pain score after 1 day, 1 week, 1 month, 3 months and 6 months were 3.5, 2, 0.58, 0.5 and 0 respectively. Seroma formation occurred in 6 (25%) and hematoma in 1 (4%) patient. The mean time to resumption of daily activities was 6.25 days. Mean CCS after 1 month and 3 months are 30 and 16.2 respectively. No cases of recurrence or chronic pain were observed during 6 months follow-up. Conclusion: Laparoscopic TARM appears to be a feasible, safe and cost-effective method of ventral hernia repair due to standard laparoscopic instruments used, no contact with bowel and use of plain polypropylene mesh respectively.

Partial Glossectomy Combined With Radiofrequency Ablation for Macroglossia in Beckwith-Wiedemann Syndrome.

As the most common feature of Beckwith-Wiedemann syndrome (BWS), macroglossia may influence the quality of life, maxillofacial growth, and speech development of children. The retrospective study aimed to investigate the therapeutic effect of partial glossectomy combined with radiofrequency ablation (RFA) for macroglossia patients in BWS. A retrospective study was conducted in BWS-derived macroglossia patients who underwent partial glossectomy combined with RFA from May 2019 to January 2021. In total, 35 patients consisting of 17 males and 18 females met the inclusion criteria and underwent surgery by the same plastic surgeon. Demographic characteristics, BWS features, operation details, preoperative and postoperative outcomes, satisfaction evaluations, and subgroup analysis were collected and assessed. Of the 35 patients involved, the average age at the time of surgery was 14.05±8.08 months, and the average surgery duration was 48.17±6.72 minutes. Only 1 patient suffered ventral tongue wound dehiscence, and the rest of the patients did not develop any other complications. The severity and frequency of tongue protrusion, drooling, snoring, and feeding difficulty were significantly ameliorated. The patient's parents showed satisfaction towards the overall surgery, tongue's appearance, and tongue's motor function. Tongue's height decreased from 32.09±1.16mm before the operation to 29.29±1.33mm after the operation. The partial glossectomy combined RFA exerts a safe, effective and viable technique to treat BWS-derived macroglossia.

Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement.

The purpose was to assess the rates of postoperative complications and the need of temporary stoma of laparoscopic surgical treatment for bowel endometriosis in a referral center. The surgical indication, type of operation, operative time, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, postoperative complications were evaluated. One-hundred and fifty patients were included. The average duration of surgery was significantly longer for segmental resection (151 minutes) than for disc excision (111.5 minutes, p < 0.001) and shaving (96.8 minutes, p < 0.001). Patients with segmental resection had longer postoperative lengths of hospital stay (1.87 days) compared with patients with disc excision (1.43 days, p < 0.001) and shaving (1.03 days, p < 0.001). A temporary stoma was performed in 2.7% of patients. Grade II and III postoperative complications occurred in 6.7% and 4.7% patients, respectively. Laparoscopic intestinal resection has an acceptable postoperative complication rate and a low need for a temporary stoma.

Supraorbital approach in surgery for lateral intracerebral hematoma

Aim: to present the experience of using the technique of endoscopic aspiration (EA) of lateral intracerebral hematomas (ICH) through the mini-supraorbital approach. Material and methods. From 2019 to 2021 at the Sklifosovsky Institute for Emergency Medicine, 12 patients with lateral ICH underwent EA of the ICH using a mini-supraorbital approach. There were 7 men (58.3 %) and 5 women (41.7 %). The mean age of the patients was 53.2±6.8 years. According to the Glasgow Coma Scale (GCS), the level of consciousness during hospitalization corresponded to 15 points in 4 (33.3 %) patients, and 11‑14 points — in 8 (66.7 %) patients. The average volume of lateral ICH was 45.3±17.4 cm3 (from 28 to 84 cm3). The average duration of the surgical intervention was within 4.2±2.1 days. The operations were performed using STORZ endoscopic equipment. Ventriculoscopes and Gaab trocars were used in 3 cases, and transparent endoscopic ports with a diameter of 8 mm and 4 mm endoscopes were applied in 9 cases. The operations were performed under the control of BrainLab frameless neuronavigation. Results. The average duration of operations was 93±18 minutes. EA through the mini-supraorbital approach provides the removal from 51 to 91 % of the intracerebral hematoma volume, 73.3±16.6 % on average. There were no complications during the operation associated with the use of the approach. The outcomes were of 0‑2 in 2 (16.7 %) patients, 3‑5 — in 8 (66.7 %), and 6 — in 2 (16.7 %) patients according to the modified Rankin Scale. Conclusion. Supraorbital approach allows efficient removal of lateral ICH. The close passage of the access trajectory to the base of the anterior cranial fossa is not an obstacle and does not reduce the radicality of blood clots removal from the ICH cavity. However, the lateral ICH removal through the supraorbital approach requires the use of frameless navigation during the entire main stage of the operation, and instead of a metal trocar, it is recommended to use a transparent endoscopic port.

Cryopreserved Amniotic Membrane Using the TissueTuck Technique: A Sutureless Approach for Pterygium Surgery.

The purpose of this study was to evaluate the clinical outcomes of the TissueTuck technique in the management of pterygium. This was a single-center, retrospective review of patients with primary or recurrent pterygium that underwent surgical excision followed by application of cryopreserved amniotic membrane (AM) using the TissueTuck technique. All patients underwent surgery between January 2012 and May 2019. Patient profile, surgical time, complications, and rates of pterygium recurrence were analyzed. A total of 582 eyes of 453 patients (328 female patients; 65.1 ± 13.9 years) were included for analysis and initially presented with primary (92%) pterygium. The average duration of pterygium excision surgery was 14.7 ± 5.2 minutes (median: 14, range: 4-39 minutes) with mitomycin C administration in 257 (45%) eyes. At the last follow-up of 30.2 ± 22.2 months (median: 24.5, range: 3-94 months), BCVA significantly improved from logMAR 0.23 at baseline to logMAR 0.19 ( P < 0.0001). Recurrence rate was 2.3% but only 0.7% (2/274) in those cases with primary, single-headed pterygium without mitomycin C treatment. Other postoperative complications in that cohort included granuloma (7.9%), scarring (3.8%), and diplopia in extreme lateral gaze (2.5%). The AM remained secured to the ocular surface throughout the postoperative period. The TissueTuck surgical technique with cryopreserved AM can be performed in minimal time and result in a low recurrence and complication rate after pterygium surgery.

Laparoscopic central hepatectomy using a parenchymal-first approach: how we do it.

Laparoscopic central hepatectomy (LCH) is a difficult and challenging procedure. This study aimed to describe our experience with LCH using a parenchymal-first approach. Between July 2017 and June 2021, 19 consecutive patients underwent LCH using a parenchymal-first approach at our institution. Herein, the details of this procedural strategy are described, and the demographic and clinical data of the included patients were retrospectively analyzed. There were 1 female and 18 male patients, all with hepatocellular carcinoma without major vascular invasion. The mean age was 57 ± 10years. No patients underwent conversion to open surgery, and no blood transfusions were needed intraoperatively. The average operative duration and the average Pringle maneuver duration were 223 ± 65min and 58 ± 11min. respectively. The median blood loss was 200ml (range: 100-800ml). Postoperative morbidities occurred in 3 patients (15.8%), including 2 cases of bile leakage and 1 case of acquired pulmonary infection; there were no postoperative complications happened such as bleeding, hepatic failure, or mortality. The average postoperative hospital stay was 10 ± 3days. The optimized procedure of LCH using a parenchymal-first approach is not only feasible but also expected to provide an advantage in laparoscopic anatomical hepatectomy.

Vasoactive-inotropic score/inotropic score and short-term outcomes in pediatrics undergoing cardiac surgery: A retrospective analysis from single center.

This study aimed to investigate the association between vasoactive-inotropic score/inotropic score (VIS/IS) and short-term outcomes in pediatric patients after cardiac surgery at a tertiary care center in an unselected pediatric population in China. This study carried out retrospective observation of 401 patients between April and June 2021 at a tertiary care center. VIS and IS were assessed intraoperatively (VIS-op, IS-op) and 2 h (VIS2h, IS2h), 24 h (VIS24h, IS24h), and 48 h (VIS48h, IS48h) postoperatively. The primary outcome was prolonged mechanical ventilation (PMV). Secondary outcomes included poor prognosis and length of stay in the pediatric intensive care unit and hospital. Mean age of the included pediatric patients was 26.5 months. Pediatric cardiac procedures were performed within an average operation duration of 167.6 ± 70.8 min. Overall, the PMV group (n = 93) experienced significantly longer ACC duration, cardiopulmonary bypass duration, operation duration, and a higher prevalence of fluid accumulation overload than the non-PMV group (n = 93). Multivariate logistic regression analysis revealed that longer operation duration (odds ratio [OR]: 1.015; 95% confidence interval [95%CI]: 1.003, 1.026; p = .012) and higher VIS48h (OR: 1.188; 95% CI: 1.077, 1.311; p = .001) were strongest predictors for PMV. VIS48h had better discrimination power for PMV than other time intervals, and the area under the curve was 0.780 (95% CI, 0.721, 0.839; p = .000). VIS48h independently predicted short-term outcomes after cardiac surgery in an unselected pediatric population in China and showed better prediction accuracy and discrimination capability than other time intervals.

Efficacy of Laparoscopic Management of Posterior Urethral Diverticulum in Anorectal Malformations

BackgroundA posterior urethral diverticulum (PUD) is a serious postoperative complication after anorectal malformation correction. Complete resection is technical demanding because of limited retrourethral working space deep in the pelvis. ObjectiveWe pioneered the single-incision laparoscopic approach for PUD excision and evaluated the efficacy. Design, setting, and participantsTwenty-six PUD patients undergoing redo surgeries between June 2011 and June 2021 were reviewed. Surgical procedureA series of transabdominal retraction sutures were placed through the PUD to facilitate dissection. The contents were evacuated to create a working space. Distal PUD dissection was carried along the submucosal layer to prevent injury of the urethra/pelvic nerve complex. The rectal mucosa was peeled off from the junction site for complete PUD excision. The muscular cuff of the distal rectum was then oversewn. MeasurementsOperative time, postoperative recovery, and complications were assessed. Results and limitationsThe mean age of redo surgery was 2.46 yr. The average operative duration was 2.35 h. The mean postoperative hospital stay, resumption of full diet, and bowel movement were 10.23, 2.15, and 1.54 d, respectively. The median follow-up period was 46 mo (12–132 mo). No remnant of PUD, recurrent fistula, or urinary leak was detected. None of the patients had difficulty in urination, urinary dribbling, urinary tract infection, constipation, or soiling. All patients retained morning erection, and two postpubertal patients had ejaculations. ConclusionsOur single-incision laparoscopic redo surgery provides an effective approach for PUD excision. It minimizes complications. It also preserves urinary and bowel continence and sexual function. Patient summaryComplete resection of a posterior urethral diverticulum (PUD) in anorectal malformation is technically demanding because of limited retrourethral working space in the deep pelvis. The outcomes of single-incision laparoscopic PUD excision were satisfactory.

Clinical and radiographic outcomes of revision with autogenous "structured" bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study.

To assess the efficacy of autogenous "structured" bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN). This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed. The average time between primitive fracture and this operative treatment was 29months (15-38months). The average duration of surgery was 153minutes (range, 115-230min), and the average blood loss was 560ml (range, 350-860ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18months (range, 12-30months). All fractures progressed to osseous healing at a mean time of 14weeks (range, 12-16weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up (P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up (P < 0.01). ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.

AN OBSERVATIONAL STUDY OF OUTCOME OF CASES OF UNCOMPLICATED ACUTE APPENDICITIS OPERATED WITHIN 12 HOURS VERSUS AFTER 12 HOURS OF PRESENTATION

Objective Ÿ To minimize number of operations during the night. Ÿ To evaluate ill effects of delaying appendectomy in acute appendicitis. Study Design: Observational study Setting: Tertiary care hospital Patients: In this study we have taken 250 cases of uncomplicated acute appendicitis which got operated at our study setting. Out of these, 125 patients were operated within 12 hours of hospital presentation and the other 125 patients were operated after 12 hours of hospital presentation. Among 125 patients of early group 68 patients were operated with open appendectomy and 57 patients were operated with laparoscopic appendectomy. Similarly, in late group, 46 patients were operated with open method and 79 patients were operated with laparoscopic method. Results:These results suggest that there is no signicant difference between uncomplicated acute appendicitis operated within 12 hours or after 12 hours of hospitalisation when compared in terms of average duration of surgery, post-operative total leucocyte count, time to start feeding after surgery, hospital stay and complications. Conclusions: We can conclude that appendectomy for uncomplicated appendicitis can be delayed safely for more than 12 hours. Delayed appendectomy after hospitalisation for uncomplicated appendicitis does not increase the morbidity of the patient.

Effectiveness of placing prophylactic mesh with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer

Abstract Introduction: The aim of this study was to assess the efficacy of parastomal hernia prevention with the Sugarbaker technique via laparoscopic abdominoperineal resection for rectal cancer after a one-year follow-up at University Medical Center in Ho Chi Minh City. Patients and methods: Intervention study. Between 11/2018 and 7/2022, 43 patients with low rectal cancer underwent laparoscopic abdominoperineal resection and were divided into two groups: intervention (n = 15) with prophylactic mesh placement using the Sugarbaker technique and control (n = 28). All patients were tracked for at least a year and had an abdominal computed tomography scan. The Kaplan Meier method was used to calculate the rate of parastomal hernia after one year. To compare the rates of parastomal hernia in two groups, the logrank test was used. Results: This study included 43 patients; the male to female ratio was approximately equal to 1:1; the median age was 62; the youngest age was 40; and the oldest age was 92. Rectal cancer stage III was found in 41.8% of people. Neoadjuvant chemoradiotherapy was used in 27.9% of cases. The average duration of operation was 184 minutes. The average time for mesh placement was 15 minutes. The overall complication rate was 16.4%. There were no issues with mesh placement. At one year, the control group had a higher cumulative rate of parastomal hernia than the intervention group (35.7% versus 0%, logrank 6.4, p = 0.01). Conclusions: Prophylactic mesh placement using the Sugarbaker technique during laparoscopic abdominoperineal resection for rectal cacner is safe, does not increase complications, and reduces the cumulative rate of a parastomal hernia at 1 year in patients who have undergone prophylactic mesh placement. Keywords: Prophylactic mesh placement, Sugarbaker technique, Laparoscopic abdominoperineal resection.