Combined Surgery Research Articles

Effects of Scalp Nerve Block on Symptomatic Cerebral Hyperperfusion Syndrome After Combined Revascularization Surgery for Moyamoya Disease.

Strict blood pressure control can be used to prevent or treat cerebral hyperperfusion syndrome. This study investigated whether scalp nerve block (SNB) is associated with a reduced risk of postoperative symptomatic cerebral hyperperfusion syndrome (SCHS) by reducing postoperative blood pressure in adult patients who underwent combined revascularization surgery for moyamoya disease. Patients were retrospectively divided into the SNB (n=167) and control (n=221) groups depending on whether SNB was performed immediately before placement of wound dressings at the end of surgery. Postoperative SCHS was defined as new-onset postoperative neurological deficits with a focal increase in cerebral blood flow at the perianastomosis site in the absence of infarction or hemorrhage on postoperative brain imaging. Inverse probability of treatment weighting was used to balance preoperative variables between the 2 groups. The incidence of postoperative SCHS did not differ between the SNB and control groups (61 [36.5%] vs. 102 [46.2%], P=0.072), but its duration was shorter in the SNB group (4 [2-6] vs. 5 [3-7] days, P=0.021). Although of limited clinical relevance, the SNB group had lower postoperative pain scores and systolic blood pressures at postoperative days 0 to 1 and a shorter intensive care unit stay. Despite some potential benefits, SNB was not associated with a reduced incidence of postoperative SCHS in adult patients who underwent combined revascularization surgery for moyamoya disease.

Lucia Keratoprosthesis in a Sclerocorneal Graft for Recurrent Graft Rejection Secondary to Herpetic Keratitis.

To report the surgical approach of a Lucia keratoprosthesis (KPro) on a sclerocorneal graft in the setting of recurrent graft rejection and perilimbal scleral thinning. A case report. We report the case of a 26-year-old man with a history of herpes simplex keratitis, 2 penetrating keratoplasties, graft failure, secondary glaucoma, and a conjunctival flap in the right eye who underwent a Lucia KPro, lens extraction, glaucoma drainage device, and pars plana vitrectomy. The surgery involved releasing the conjunctival flap, revealing severe perilimbal scleral thinning. The use of a sclerocorneal graft to mount the Lucia KPro allowed an effective combined procedure by providing a healthy sclera. At the last follow-up (34 months), the patient had retained the Lucia KPro and had a best-corrected visual acuity of 20/400. The Lucia KPro on a sclerocorneal graft may be a viable option to provide healthy sclera in patients requiring combined KPro surgery.

Intra-individual comparison of long-term outcomes between combined and indirect bypass surgery in adult moyamoya disease

PurposeBypass surgery is regarded as the standard treatment option for symptomatic and hemodynamically unstable moyamoya disease (MMD). However, there is ongoing debate about the most effective type of bypass surgery. We aimed to analyze the long-term outcomes of combined and indirect bypasses for MMD patients through intra-individual comparisons.MethodsOf the 896 patients who underwent 1084 bypass surgeries between 2007 and 2021, 24 patients with MMD who underwent combined bypass on one side and indirect bypass on the other side were ultimately enrolled in this study. Clinical, angiographic and hemodynamic outcomes were retrospectively evaluated.ResultsThree asymptomatic strokes (12.5%) occurred within 30 postoperative days in each group. Postoperative strokes after 30 days occurred in 3 patients (12.5%) with 3 hemorrhagic events and 1 cerebral infarction, only in indirect bypass, while no stroke occurred in hemispheres treated with combined bypass. The revascularization area relative to supratentorial area was significantly greater in combined bypass than in indirect bypass, both in short-term and long-term periods (64.9% versus 43.9% in short-term and 75.7% versus 54.9% in long-term; P < .001, respectively). Hemodynamic outcomes showed significantly greater increases in acetazolamide-challenged cerebral blood flow (CBFacz) during short-term follow-up (P = .04) and in both basal CBF (CBFbas) and CBFacz during long-term follow-up (P = .014 and P = .009, respectively) in combined bypass than in indirect bypass.ConclusionCombined bypass may be a more effective treatment option for MMD based on its higher revascularization area and favorable hemodynamic results compared to indirect bypass in the same patient.

Combined Phacoemulsification, Goniosynechialysis and Ab Interno Trabeculectomy in Primary Angle-closure Glaucoma: Long-term Results.

Objective: This research was designed to evaluate the efficacy and safety of ab-interno trabeculectomy (Trabectome and Kahook Dual Blade) combined with phacoemulsification, intraocular lens implantation, and goniosynechialysis in eyes with primary angle-closure glaucoma. Methods: A total of 47 patients were included in the study and all the patients received the combined surgery. Intraocular pressure, anti-glaucoma medications, best-corrected visual acuity, and the number of peripheral anterior synechiae quadrants were recorded at baseline and at various time points after surgery. Results: Intraocular pressure decreased significantly from 20.93 ± 6.53 mmHg preoperatively to 15.09 ± 3.63 mmHg (P < 0.001) at 36 months. The number of glaucoma medications was significantly reduced from 2.45 ± 1.18 preoperatively to 1.25 ± 1.55 (P = 0.001) at 36 months. The success rate of the combined surgery was 90.0% at 36 months. The decrease of intraocular pressure exhibited a positive correlation with the baseline intraocular pressure (P < 0.001), while the reduction in the number of glaucoma medications was positively correlated with the baseline number of glaucoma medications (P < 0.001). Best-corrected visual acuity improved from 0.39 ± 0.29 to 0.48 ± 0.34 at 1 month (P = 0.005). There were no vision‑threatening complications intraoperatively or postoperatively. Conclusion: The combined surgery has been proven to be effective and safe for patients with primary angle-closure glaucoma in the long term, suggesting that combined surgery may be beneficial for patients with primary angle-closure glaucoma, especially those with long-term and extensive peripheral anterior synechiae.

Cataract surgery combined with glaucoma surgery.

This review evaluates the surgical management of glaucoma in patients undergoing cataract surgery. Combining both procedures present challenges in balancing intraocular pressure (IOP) control, minimizing postoperative complications, and achieving optimal refractive outcomes. Recent studies highlight the effectiveness of combined glaucoma and cataract surgeries, with traditional filtering surgeries and MIGS showing significant IOP reduction. The abundance of long-term studies shows that MIGS can offer an effective and safer alternative when carefully tailored to meet the specific needs of each patient. Combining glaucoma and cataract surgery is a promising approach for patients with coexisting conditions. While traditional surgeries offer robust IOP reduction, MIGS procedures offer better safety profiles with fewer complications and more predictable refractive results. Surgeons must carefully consider the timing and choice of procedures, with further research required to develop standardized treatment algorithms.

Planning and performing simultaneous bariatric surgery and robotic hysterectomy in a super-obese patient with endometrial cancer.

Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and endometrial intraepithelial neoplasia (EIN) is the defined precancerous lesion. Obesity is considered a risk factor for both EC and EIN. On the other hand, mortality is often attributed to obesity-related conditions in patients with early-stage EC. Bariatric surgery has been shown to improve oncological outcomes and obesity-related morbidity and mortality in patients with EC. Therefore, combination surgery addressing both uterine disease and obesity is a very recent point of interest. Here, we present a video article to demonstrate the crucial surgical steps for a simultaneous robotic-assisted total laparoscopic hysterectomy and sleeve gastrectomy in a patient with super obesity and EIN. A patient in her 40s with a body mass index of 62.4 kg/m² and a diagnosis of EIN was scheduled for combo surgery. The operation started with sleeve gastrectomy in the reverse Trendelenburg position. The da Vinci Xi Surgical System™ (Intuitive Surgical Inc., Sunnyvale, CA, USA) with left-side docking was used for surgery. After the mobilization of the stomach, gastric resection was performed using a stapler. Following sleeve gastrectomy, the patient was positioned in the Trendelenburg position, and the robotic system was positioned for hysterectomy. Hysterectomy and salpingectomy were performed. The excised stomach and hysterectomy material were removed through the vagina. A frozen examination revealed EC below 2 cm with superficial invasion, and bilateral oophorectomy was performed. The whole surgery took approximately 4 hours. No postoperative complications occurred, and the patient was discharged on the 3rd day.

An internally validated prognostic nomogram model predicts the stone-free rate following endoscopic combined intrarenal surgery for renal stones

BackgroundHere, we aim to develop and validate a viable prognostic nomogram model for predicting a stone-free rate of kidney stones patients based on retrospective cohort analysis.MethodsThis is a retrospective study that obtained a continuous cohort from the databases of two hospitals (General Hospital of Southern Theater Command, and Guangdong Second Provincial General Hospital), including 522 patients with kidney stones who underwent Endoscopic Combined Intrarenal Surgery (ECIRS) from January 2015 to December 2022.The characteristics of the primary cohort between the SF (stone-free) and SR (stone residue) groups were identified using single factor and multivariate logistic regression analyses. Factors in the main cohort were identified using minimal absolute shrinkage and selective operator regression. A nomogram was then constructed using these factors for subsequent analyses. Finally, a calibration curve, a receiver operating characteristic curve (ROC), and a decision curve analysis (DCA) curve were analyzed and plotted, and then used to test the predictive value of the nomogram in both calibration and discrimination.ResultsHydronephrosis, Renal Infundibular Length (RIL), Renal Infundibular Width (RIW), stone burden, and number of calyces involved were revealed to be significant factors in the prediction of stone-free rate after ECIRS. These five factors were used to develop a nomogram with good calibration and differentiation. The area under the curve (AUC) was 0.811 (95% CI: 0.766–0.856). The DCA demonstrated that the nomogram has clinical utility.ConclusionsHydronephrosis, renal infundibular length, renal infundibular width, stone burden, and number of involved calyces were all significantly linked with residual stone after ECIRS. A nomogram created with these five factors showed good calibration, differentiation, and clinical usefulness.

Epiretinal Membrane and Senile Cataract: Combined vs Sequential Surgery.

To evaluate the outcomes of combined phacovitrectomy versus sequential phacoemulsification and vitrectomy in patients with both senile cataract and epiretinal membrane (ERM). A retrospective multicenter study was conducted between 2014 and 2022 at two hospitals in Italy. Patients with idiopathic ERM and senile cataract in the same eye were enrolled and underwent either combined (n=38) or sequential surgery (n=38), performed by a single surgeon. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at 1, 3, and 6 months after surgery. Both surgical approaches significantly improved BCVA and reduced CMT after 6 months. However, sequential surgery showed faster visual recovery, with significant improvements in BCVA (P=0.008) and CMT (P<0.0001) observed as early as 1-month post-surgery, compared to the combined group. Although both surgical approaches yielded significant improvements in visual acuity and central macular thickness at 6 months, the sequential approach offered a faster recovery in the early postoperative period. According to the literature, the sequential approach also allows some patients to be satisfied after cataract surgery alone, potentially avoiding unnecessary vitrectomy and reducing the risk of overtreatment.

Mini-endoscopic combined intrarenal surgery (mini-ECIRS) for complex urolithiasis.

To miniaturize endourological procedures, mini-Endoscopic Combined Intrarenal Surgery (mini-ECIRS) has emerged as a promising alternative in the treatment of complex kidney and ureteral stones. To date, some data available in the literature have shown good outcomes regarding effectiveness and safety. This study aimed to evaluate the results and postoperative complications of mini-ECIRS in our series. A prospective analysis of consecutive patients who underwent mini-ECIRS at our center between June 2022 and March 2024 was performed. Demographic characteristics were collected, and the patients were divided according to de Guy's Stone Score (GSS). The stone-free rate (SFR) was classified into the grades according to non-contrast abdominal computed tomography 4 weeks after the procedure: Grade A (no stones), Grade B (< /= 2mm fragments), and Grade C (2.1-4mm fragments). 60 patients were included and enrolled in the study. The median stone volume was 3352 mm3 (2602-4573) and the median stone density was 1054 HU (774-1284). SFR Grade A was achieved in 48 patients (80%) and Grade C in 12 patients (20%). Thirteen patients (21.7%) presented Clavien-Dindo Grade I-II complications. When we divided the patients into two groups according to the GSS classification, GSS 1-3 presented significantly fewer postoperative complications and higher SFR. Mini-ECIRS is a safe and effective procedure for treating of complex renal and ureteral stones. Patients with GSS 4 are more likely to need a second look procedure and present a higher probability of postoperative complications. Larger and randomized studies are required to confirm these favorable outcomes.

Multidisciplinary management of primary umbilical endometriosis (Villar’s nodule) with coexistent uterine leiomyomata: A case report

Introduction: Primary umbilical endometriosis, also known as Villar’s nodule, is a rare manifestation of endometriosis within the umbilicus. Case description: A 41-year-old female who presented with a 4-year history of umbilical swelling associated with cyclic umbilical bleeding, dysmenorrhoea and heavy menstrual bleeding is herewith reported. Imaging procedures revealed an umbilical mass and uterine leiomyomas. The patient underwent combined surgery by the gynaecology and plastic surgery teams where an open myomectomy followed by omphalectomy, mesh repair of the rectus sheath and panniculectomy was done. Histopathological examination confirmed the presence of estrogen and progesterone receptor-positive endometrial glands and stroma in the umbilicus consistent with primary umbilical endometriosis and coexistent uterine leiomyomas. Clinical improvement was demonstrated 3 months following the surgery. Conclusion: Umbilical swelling associated with catamenial symptoms should raise suspicion for primary umbilical endometriosis. Inter-specialty approach is key in the management of primary umbilical endometriosis.

Combined Penetrating Keratoplasty and Vitrectomy: Long-Term Follow-Up Results.

Purpose: To assess the long-term outcomes of combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV). Methods: A retrospective review of eyes that underwent combined surgery followed for 12 months or longer. Demographic data, indications for surgery, and pre-/post-surgical eye examinations were retrieved. Results: Thirteen consecutive eyes (13 patients) were enrolled. The mean age was 51.5 ± 20.5 years, and the mean follow-up time was 67 ± 36.9 months. All cases had severe corneal opacity. Indications for surgery included retinal detachment (76.9%), dropped lens (7.7%), dropped intraocular lens (7.7%), and endophthalmitis with corneal abscess (7.7%). Visual acuity improved in 46.1% of the cases, though in most cases visual acuity remained low, and decreased in 23% of the cases. In 23% of the cases (3 eyes), ambulatory vision was achieved for more than 12 months and in 15.4% for three years. Silicone oil tamponade was used in all cases of retinal detachment (10 eyes). Of these eyes, at the final follow-up, four eyes were attached, two eyes were partially attached, and corneal opacity prevented retinal visualization in three eyes. One eye was eviscerated and one eye developed phthisis. Postoperatively, 61.5% of the cases underwent repeated PKP for graft decompensation. At the final visit, graft failure was observed in 75% of the cases. Conclusions: The long-term follow-up of eyes that underwent combined PKP and PPV supports this technique in complex cases for eye and vision preservation. The main problem after combined surgery is the long-term survival of the corneal graft which may require repeated PKP surgeries. With this approach, in 23% of the cases, ambulatory vision was maintained for more than 12 months.

The cerebellar glucose metabolism in moyamoya vasculopathy and its correlation with neurocognitive performance after cerebral revascularization surgery: a [18F]FDG PET study.

The vascular cognitive impairment (VCI) is quite common in moyamoya vasculopathy (MMV). However, the abnormality of cerebellar glucose metabolism in MMV and its relationship with patients' neurocognitive performance were few reported. In this study, we aimed to investigate the relationship between neurocognitive performance and cerebellar glucose metabolism. Furthermore, the cerebellar glucose metabolism changes after combined revascularization surgery were also researched. We retrospectively analyzed the 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography ([18F]FDG PET) images and their neuropsychological scales in 93 eligible MMV patients by comparing their cerebellar standardized uptake values ratio (SUVR) and metabolic covariant network (MCN) among different neurocognitive groups. Then, forty-two MMV patients with VCI who underwent combined revascularization surgery were prospectively observed. According to their neuropsychological performance at 6-month follow-up, these patients were assigned to cognitive improved group (n = 22) and non-improved group (n = 20). The cerebellar SUVR and MCN changes were also analyzed. SUVR of right Lobule VI/Crus II/VIII decreased when cognitive impairment progression (P < 0.05, Least-Significant Difference [LSD] post hoc analysis). The cerebellar glucose metabolic pattern can be divided into two parts, in which the cerebellar posterior lobe was positively related to patients' neurocognitive performance, while the vermis and anterior lobe showed negative relationship with the neurocognitions (P < 0.001). Further MCN analysis expound that the degree of right Lobule VI/Crus II/VIII displayed decreased tendency as cognitive impairment worsened (P < 0.05, LSD post hoc analysis). After revascularization surgery, the SUVR of right cerebellar posterior lobe significantly promoted in improved group (P < 0.001). Besides, we also witnessed the SUVR improvement in left cerebral hemisphere, thalamus, and red nucleus (P < 0.001). The MCN analysis revealed that the posterior connective strength improvement among right Lobule VI and several cerebral regions significantly correlated with memory and executive screening (MES) score (P < 0.001, false discovery rate corrected). We found that the hypometabolism of cerebellar posterior lobe, especially in the right Lobule VI, was associated with MMV patients' neuropsychological performance, while the anterior lobe and vermis showed opposites tendencies. Combined revascularization surgery improved the posterior cerebellar metabolism and was associated with favorable neurocognitive outcomes, which might be related to the activation of cortico-rubral-cerebellar pathway.

Preserflo MicroShunt Implantation: A Narrative Review of Its Standalone Benefits vs. Combined Use with Phacoemulsification in Managing Open-Angle Glaucoma.

Glaucoma and cataract often coexist. Patients with both conditions who qualify for surgical treatment may undergo either a combined surgical procedure or sequential treatments such as cataract surgery followed by an antiglaucoma procedure. A combined procedure with phacoemulsification is related to an increased risk of fibrosis of the filtering bleb; however, it is a rational approach for patients with high intraocular pressure and clinically significant lens opacification. Trabeculectomy has been a traditional filtration procedure for decades, effectively lowering intraocular pressure. It is highly effective; however, it may cause sight-threatening complications. The Preserflo MicroShunt, introduced less than a decade ago in the field of glaucoma surgery, has shown similar hypotensive efficacy to trabeculectomy, and is a less invasive procedure with a better safety profile. Despite their shared mechanism of action to reduce intraocular pressure, the two procedures differ in the extent of scleral incision and filtration bleb morphology, which may influence the extent of the post-surgery inflammation process. This review evaluated and compared reports on the efficacy and safety of Preserflo MicroShunt implantation as a standalone procedure versus combined with cataract removal in surgical treatment for patients with open-angle glaucoma and concomitant cataract.

Congenital tracheal stenosis with complete cartilage rings: proposal of a multidisciplinary and tailored surgical approach.

IntroductionCongenital Tracheal Stenosis (CTS) with complete cartilaginous rings is a rare but potentially life-threatening condition in paediatric patients. Currently, the most common approach is slide tracheoplasty (ST) with sternotomy under cardiopulmonary bypass (CPB). Intending to make the procedure less invasive and consider the variety of associated conditions, we have tailored the approach to our patients, who were treated by a multidisciplinary airway team. MethodsPatients with CTS treated surgically between 2012 and 2022 at Gaslini Institute were enrolled. Preoperative, surgical and postoperative details were collected and analysed retrospectively. All patients had angio-computerized tomography (CT) scan, echocardiography and bronchoscopy with bronchography before surgery. Each patient and each procedure have been discussed at Airway Team meetings. ResultsAmong 20 patients with CTS, 15 underwent ST and 5 tracheal resection and anastomosis (TRA). 60% were younger than 12 months. 30% patients had previous tracheal/cardiac surgery. Combined cardiac surgery was performed in 8 patients. 4 patients were approached with cervicotomy and extracorporeal membrane oxygenation (ECMO). Mortality within 30 days was 5%. 8 patients (40%) needed endoscopic dilatation after the surgery and 1 underwent revision surgery. No patient had tracheostomy after the surgery. We did not find a higher rate of mortality and morbidity in patients who had cervicotomy and ECMO. ConclusionWe propose a multidisciplinary and tailored approach for patients with CTS. After evaluating each patient through detailed preoperative studies, including bronchography, the team can choose alternatives to the traditional ST under CPB, such as TRA, cervical approach, and ECMO. Level of evidenceLevel IV Type of studyOriginal article

Endoscopic Combined Intrarenal Surgery: best practices and future perspectives.

Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS. A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications. ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes. ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones.

Analysis of Intraocular Lens Rotation during Combined Vitrectomy and Cataract Surgery

Analysis of Intraocular Lens Rotation during Combined Vitrectomy and Cataract Surgery

Comparison of early and late term results of onlay and sublay mesh approaches in open incisional hernia surgery

Aims: Despite the increase in minimally invasive techniques, open techniques continue to be frequently used in incisional hernia repairs. In open incisional hernia surgeries, onlay and sublay techniques are the most frequently preferred depending on the area where the mesh is placed. In this study, we aimed to compare these two techniques by analyzing perioperative findings. Methods: Data from elective open incisional hernia surgeries (onlay and sublay) performed by the same surgical team in the general surgery clinic between 01.01.2023 and 31.12.2023 were retrospectively reviewed. Emergency surgeries, laparoscopic or combined surgeries, patients who did not undergo mesh repair, patients who received preoperative botulinum toxin due to “loss of domain”, patients with missing data, and patients who did not continue their follow-up were excluded from the study. Results: The data of a total of 74 patients who met the inclusion criteria were analyzed in the study. Onlay procedure was performed in 53 (71%) patients and sublay procedure was performed in 21 (19%) patients with a retromuscular approach. No intraoperative complications were detected in any of the patients. There were statistically significant differences between the groups in terms of female gender (p: 0.007), duration of surgery (p&lt;0.001) and duration of hospital stay (p&lt;0.001). There were no statistically significant differences between the groups in terms of complications (p:0.42), unexpected re-admission (p:0.779) and six-month recurrence (p: 0.779). Conclusion: Onlay or sublay techniques can be safely applied in open incisional hernia surgery because they have acceptable complication and recurrence rates. Surgical experience and patient factors are the main determinants of which technique to apply.

Outcome of combined surgery with compression therapy for management of venous leg ulcer

Background: Venous leg ulcers (VLUs) are late indicators of chronic venous insufficiency (CVI) and venous hypertension. Compression therapy (CT) with multilayer bandage is the first line of treatment modality of ulcer management. But CT has a slow ulcer healing rate and high chance of recurrence. The present study was conducted to identify the outcome of combined surgery with compression therapy to manage VLU. Methods: In this prospective study, 60 patients were included who presented to the department of cardiovascular surgery of Dhaka Medical College and Hospital between January 2021 to December 2023. The patients were divided into two groups. Group A included the patients who underwent surgery combined with compression therapy while Group B patients received only compression therapy (CT). Ulcer healing time, recurrence rate and Venous Clinical Scoring System (VCSS) were analysed to determine the outcome. Results: There was no significant difference in the demographic variables between two groups. 30 limb ulcers healed in the combined treatment group with a median healing time of 1.6 months (95% CI, 1.42–1.82), while 24 limb ulcers healed in the CT alone group with a median healing time of 2.15 months (95% CI, 1.92–2.45). The ulcer healing time was shorter in the combined treatment group than in the CT alone group (HR for ulcer healing 1.98, 95% CI, 1.474–2.309, p&lt;0.05). Recurrence rate was higher in CT group (16.66% vs 53.33%). Besides VCSS was lower in Combined group that CT group after 1month, 6 month and 12 month of follow-up which was statistically significant. (p&lt;0.05) Conclusions: The present study has demonstrated combined treatments can shorten the ulcer healing time and reduce the ulcer recurrence rate compared with CT alone for treating VLU. Further randomized large scale multicenter study is recommended to provide a better management to the patients.

Indirect Decompression in Vertebral Reconstruction for Osteoporotic Vertebral Fractures with Neurological Symptoms: A Preliminary Case Series.

This study aimed to investigate the clinical and radiological outcome of "indirect decompression" using lateral-posterior combined surgery for osteoporotic vertebral fracture (OVF) with neurological symptoms. A total of 17 patients who underwent lateral and posterior combined indirect decompressive spinal reconstruction (LP-IDR) for single-level OVF with neurological symptoms were included in this study. The neurological symptoms (sensory disturbance and muscle weakness) and imaging findings (local angle and height of the fracture segment and bone fragment occupancy in the spinal canal) were investigated preoperatively, postoperatively, and at the 1-year follow-up. Muscle weakness was observed preoperatively in ten patients. Nine patients had complete recovery of muscle weakness (p<0.001), whereas one had residual muscle weakness at the 1-year follow-up. The presence of sensory disturbance was observed in 16 patients preoperatively, and it was significantly reduced to 8 patients at the 1-year follow-up (p=0.003). The bony fragment occupancy rate in the spinal canal was decreased from 44.0% to 40.2% postoperatively (p=0.04) and to 33.1% at 1 year (p=0.002). The local angle was corrected from 8.3° to -2.6° postoperatively (p=0.003) and to 1.2° at 1 year. The local height was corrected from 26.7 to 32.0 mm postoperatively (p<0.001) and to 29.8 mm at 1 year. LP-IDR for OVF with neurological symptoms provided sufficient neurological improvement with expansion of the spinal canal over time.

Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy applications in upper and lower gastrointestinal cancer, a review.

Peritoneal metastases (PM) are the spread of tumor forms into the peritoneum as metastases from another organ. PM is a frequent condition in metastatic gastrointestinal cancer (colorectal, gastric, pancreatic, appendiceal, and cholangiocarcinoma); their presence confers a poor prognosis, reducing patient survival. The standard treatment consists of systemic chemotherapy according to current guidelines. In recent years, scientific evidence has shown how combined cytoreductive surgery (CRS) techniques followed by hyperthermic intraperitoneal chemotherapy (HIPEC) can improve survival in this patient population. Despite the results still obtained, using this combined technique is still under discussion. This review aims to highlight the benefits and limitations of this combined procedure, which is already widely used to treat peritoneal metastases in gynecological tumors.