Common Intraoperative Complication Research Articles

V10-11 INTRAOPERATIVE COMPLICATIONS OF ROBOTIC-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-11 INTRAOPERATIVE COMPLICATIONS OF ROBOTIC-ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION David G. Ortega, Michael Chevinsky, Ryan Powers, Anibal La Riva, Laura C. Perez, Aref S. Sayegh, Erik P. Castle, John W. Davis, Monish Aron, Mihir M. Desai, Inderbir S. Gill, and Rene Sotelo David G. OrtegaDavid G. Ortega More articles by this author , Michael ChevinskyMichael Chevinsky More articles by this author , Ryan PowersRyan Powers More articles by this author , Anibal La RivaAnibal La Riva More articles by this author , Laura C. PerezLaura C. Perez More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Erik P. CastleErik P. Castle More articles by this author , John W. DavisJohn W. Davis More articles by this author , Monish AronMonish Aron More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted radical cystectomy with intracorporeal urinary diversion (RARC-ICUD) is now widely considered a standard of care treatment for muscle invasive bladder cancer with equivalent oncologic and functional outcomes compared to traditional open radical cystectomy with extracorporeal urinary diversion. RARC and ICUD each pose their own unique set of intraoperative challenges, which must be overcome and may contribute to its high complication rate. In one study of 132 patients who underwent RARC-ICUD, 30-day and 30 to 90-day complication rates were 47% and 27%, respectively. Herein, we present some of the most common intraoperative complications during RARC-ICUD and describe how to recognize and avoid them. METHODS: A compilation of video clips was collected anonymously from several surgeons to demonstrate the different intraoperative complications during RARC-ICUD. Complications were divided into those which arise during the RARC and those which arise during the ICUD. The cystectomy complications shown are multiple rectal injuries during the posterior plane dissection, sponge-stick inadvertently placed in the rectum instead of the vagina, obturator nerve injury while stapling the bladder pedicles. The reconstructive complications included right iliac artery injury during the mesenteric window creation, bowel serosa injury due to excessive traction, and several stapling complications during the ileo-ileal anastomosis such as ureter stapling to the bowel, adjacent bowel stapling, inadvertent stapling outside the lumen of the bowel, and staple line bleeding. RESULTS: Increases in operative time of patients experiencing an intraoperative complication are expected. Higher blood loss can be seen if vascular structures are involved. Increases in length of hospital stay may occur depending on the type of complication, and sequelae can occur. CONCLUSIONS: Many of the common intraoperative complications of RARC-ICUD can be easily recognized and often avoided when careful attention is paid to each step of the surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e758-e758 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David G. Ortega More articles by this author Michael Chevinsky More articles by this author Ryan Powers More articles by this author Anibal La Riva More articles by this author Laura C. Perez More articles by this author Aref S. Sayegh More articles by this author Erik P. Castle More articles by this author John W. Davis More articles by this author Monish Aron More articles by this author Mihir M. Desai More articles by this author Inderbir S. Gill More articles by this author Rene Sotelo More articles by this author Expand All Advertisement Loading ...

STUDY OF INTRAOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING SMALL INCISION CATARACT SURGERY AT A TERTIARY CARE CENTRE: A DESCRIPTIVE STUDY

Background: In India,Cataract is the leading cause of avoidable blindness.2 and cataract surgery forms the major workload of most ophthalmic units in the country. An estimated 4 million people become blind because of cataract every year,3 which is added to a backlog of 10 million operable cataracts in India, whereas only 5 million cataract surgeries are performed annually in the country.4 Thus, a technique of cataract surgery that is not only safe and effective but also economical and easy for the majority of ophthalmologists. It is estimated that about 25% of poor outcomes of cataract operations performed in developing countries annually are due to surgical complications.19 Minimizing intraoperative complications of cataract surgery is an important step towards eliminating visual impairment caused by such complications. Aim & Objective:1. To study intra-operative complications of manual small incision cataract surgery. 2. To study the visual outcome in patients of intra-operative complications following its management. Methods: Prospective cross sectional study, Study setting: Ophthalmology Department of tertiary care centre Study Duration: 2 years (October 2018 to December 2020).Study population: All patients with cataract requiring surgery admitted in tertiary care center Sample Size: 700 Results: Majority of study subjects belongs to age group 41 -40 years contributing 511 cases (73%) followed by age group 65 yrs and more 133 (19%),16-40 age group 35 (5%) and 15 years or less 21 (3%) respectively. males contributing 390 cases (55.71%) followed by females 310 cases (44.29%).Male: Female ratio is 1.25: 1. preoperative visual acuity in operated eye is in the range of < 3 /60 - Perception to light (PLPR) in majority of subjects contributing 497 cases (71%) followed by 161 cases (23%) in between < 6/ 60 - 3 /60 group, 35 cases (5%) in < 6 /18 to 6 /60 group and 7 cases (1 %) in 6 /18 or better group respectively. most common intraoperative complication was posterior capsular rent contributing 19 cases (2.71%) followed by iris prolapse 14 cases (2%), premature entry 10(1.43%), Descemet's membrane stripping 10 (1.43%), intraoperative hyphaema 8 (1.14%), capsular extension in 7 cases(1%) Iridodialysis in 5 (0.71%) and zonular dialysis in 5(0.57%) respectively Conclusions: Rate of complication was higher in hypermature type of cataract .There was no statistical signicant association between age and intraoperative complications.

A Systematic Review on Three Major Types of Scleral-Fixated Intraocular Lens Implantation.

We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. Systematic review. We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.

English

BACKGROUND Traumatic cataract is one of the common sequelae following ocular injury. It is one of the leading causes of preventable blindness. Ocular trauma leading to traumatic cataract, if managed early gives good visual outcome. Associated ocular structure involvement has much bearing on the management and prognosis of traumatic cataract. We wanted to study the visual outcome of cataract surgery in traumatic cataract. METHODS All patients included in this prospective study were subjected complete ocular examination, intra ocular lens (IOL) power calculation and small incision cataract surgery (SICS) with IOL implantation. Visual outcome was assessed after 1st week, 2 nd week, 6th week and 6 months. Postoperative visual outcome and post-operative complications were assessed. RESULTS Out of 50 cases studied, 56 % of cases were in the age group of less than 20 years. Male: Female ratio was 2.57 : 1. Traumatic cataract was higher in patients of rural background as compared to urban background (64 % vs 32 %). In 58 % of cases, penetrating injury was the type of trauma. 60 % of patients had visual acuity of less than 3/60 at presentation. Corneal injuries (34 %), scleral tear in (22 %) and iris related problems (18 %) were the most common associated findings. All the patients were treated with SICS with IOL implantation. Most common intra-operative complication was posterior capsule rupture seen in 14 % of cases, 34 % of patients had anterior uveitis as early post-operative complication and 24 % of patients developed PCO as late post-operative complication; 68 % of the patients achieved visual acuity of above 6/18. CONCLUSIONS Timely management and involvement of other structures in traumatic cataract determines the visual prognosis of cataract surgery in traumatic cataract. Thus, our study showed that traumatic cataract can be successfully managed surgically with intraocular lens implantation with good visual outcome, unless there is associated corneal opacity or posterior segment involvement. More emphasis should be laid on the preventive measures like mass health education and awareness about risk of ocular trauma, and need to adopt safety measures should be focused, especially during playground, and at workplace. KEYWORDS Traumatic Cataract, Small Incision Cataract Surgery, IOL, Visual Acuity

A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital.

The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

Comparative Study between Two Doses of Intravenous Ondansetron on Maternal Haemodynamics during Elective Caesarean Delivery under Spinal Anaesthesia

Abstract Background: Hypotension is one of the most common intra-operative complications associated with spinal anaesthe-sia. Its incidence in caesarean section has been estimated to be as high as 50-60%. Despite fluid preloading, lateral uterine displacement and the use of vasopressor agents. It occurs due to sympathetic block which leads to autonomic nervous system disturbances and a decrease in systemic vascular resistance. This can occur because the level of block must be at least at T4 to ensure adequate analgesia severe hypotension following spinal anaesthesia in caesarean section is a dangerous com-plication. If it is unnoticed or inadequately treated, it can lead to serious maternal or fetal compromise. Aim of Study: To evaluate the effect of two doses of prophylactic ondansetron on spinal anesthesia-induced hypo-tension and bradycardia among patients undergoing elective cesarean deliveries. Patients and Methods: This study was carried out in Ain Shams Hospital Obstetric Theatres from March 2020 to September 2020. Written informed consent was obtained from every parturient included in the study. Ethical approval for this study was provided by the Ethics Committee of Faculty of Medicine, Ain Shams University. FAMSU MS 155/2020 (FWA 000017585) 23/2/2020. Results: In our study, there is statistically significant difference between the studied groups regarding dose of vasopressor use. About 53.3% and 46.7% of those within ondansteron 4mg group received 10 and 12.5mg respectively. About 51.1% and 48.9% of those within ondansteron 8mg group received 12 and 15mg respectively. In terms of side effects, no patient within either group developed shivering, vomiting or bradycardia. Regarding nausea, there is statistically non-significant difference between the studied groups regarding occurrence of nausea. Conclusion: Prophylactic bolus of intravenous onandsetron 8mg and to a lesser extent 4mg could decrease the fall in the MBP of parturients following spinal anesthesia as well as ephedrine needed dose that could decrease neonatal acidosis associated with ephedrine use.

Outcome and Complications of Phacoemulsification Combined with Pars Plana Vitrectomy

Aim: To determine the outcomes of phacoemulsification also examine the complications associated to phacoemulsification combined with pars plana vitrectomy. Study design: Observational study Place and duration of study: Department of Ophthalmology, Khawaja Muhammad Safdar Medical College, Allama Iqbal Memorial Teaching Hospital, Sialkot, from 15th July 2020 to 14thJanuary 2021. Methodology: Twenty patients of both genders whom had undergoing phacovitrectomy were included. Patient’s ages were ranging from 20 to 80 years. Patient’s detailed medical histories were examined after taking informed consent. Patient’s retinal diagnosis, intraocular pressure, visual acuity, intra and post-operative complications were recorded. All the patients had received clear corneal phacoemulsification and 23-guage pars plana vitrectomy. Results: There were 15(75%) male patients while 5(25%) female patients with mean age was 54.52±12.45 years. Five patients (25%) had vitreos hemorrhage, 7(35%) patients had rhegmatogenous retinal detachment, 3(15%) patients had intraocular foreign body, 2(10%) had epiretinal membrane, 2(10%) had macular hole and 1(5%) had tractional retinal detachment. Miosis and rupture of posterior capsule were the most common intraoperative complications found in 85% and 10%. Fibrin was found in 3 (15%) cases, posterior synechia was found in 2 (10%) cases. Conclusion: The phacoemulsification with pars plana vitrectomy is safe and effective treatment modalities in patients with cataract coexist with vitreoretinal disease. Keywords: Phacoemulsification, Pars plana vitrectomy, Cataract, Complications, Outcomes

61 Peri-operative complications after hysterectomy for pelvic organ prolapse at a safety net teaching hospital: An observational cohort study

Complication rates based on coding data may be under-represented at safety net hospitals because of the nature of their payor mix. Our goal was to describe the surgical complications associated with hysterectomy for pelvic organ prolapse at a safety net hospital. A secondary objective was to identify modifiable risk factors for surgical complications. This is a retrospective cohort study of women who underwent hysterectomy for pelvic organ prolapse between July 2007 and July 2019 at a large, teaching, safety net hospital. All surgical hysterectomy cases were reviewed and were included if performed for pelvic organ prolapse. Cases were excluded if the indication for hysterectomy included malignancy or atypical hyperplasia. Medical records were reviewed for demographic data, operative details, and 6-month post-operative course. All complications were classified using the Dindo system. Univariate and multivariate analyses were performed. This study was IRB approved. 759 cases were identified. 156 (20.6%) had a complication of any kind. In four cases, the complication was not related to the surgery and did not have a Dindo classification. Of the complications, 30.9% were class I, 50.7% were class IIa, 11.2% were class IIb, 3.9% were class IIIa, 3.3% were class IIIb, and no complications were classified as class IV or V. Both of the class IIIb complications were sepsis due to a cuff abscess. Intra-operative complications accounted for 20.5% of complications, but some patients had both an intra-operative and a postoperative complication. Complication rates based on procedure type were: 19.1% for vaginal, 28% for laparoscopic/robotic and 17.4 % for open hysterectomy (P=0.22). Bladder injury was the most common intra-operative complication (9.6% of all complications), while ureteral injuries (0.6%) and bowel injuries (1.9%) were less common. The most common type of post-operative complications were urinary tract infections (UTIs) (21.2% of complications) and abdominal wound complications (7.1%). Unscheduled emergency room or triage clinic visits were common (22.4% of patients with a complication). Univariate analysis revealed that estimated blood loss (EBL) was the only demographic or procedural finding that was associated with risk of complication. This finding persisted on multivariate analysis. Approximately 20% of hysterectomies for prolapse at a safety net hospital had a peri-operative complication. High blood loss was associated with peri-operative complications. Most complications were not serious, but most of the serious complications were related to infection.

Complications of Acute Acetabular Fractures Surgical Treatment: Systematic Review

Background.The combination of classical anterior and posterior approaches, as well as their modifications, is recognized as the most effective in acetabular fractures surgical treatment. The use of classical and modified approaches is accompanied by serious intra- and postoperative complications associated primarily with the duration of surgery, significant blood loss, tissue trauma, surgical site infection. The aim of review — to determine the main and most frequent complications associated with surgical approaches to the acetabulum. material and methods. Access to literature sources is carried out in the information systems and databases PubMed/Medline, Embase, Scopus, Сochran Library, eLibrary, Wiley Online Library. Keywords: acetabular fractures, surgical treatment, approach to the acetabulum, total hip replacement.Results. The most common intraoperative complications are incorrect fragments reduction, sciatic nerve injury, less often — intraarticular implant position, damage to the superior gluteal artery and other vessels, among the early postoperative complications - wound infection, both superficial and deep, less often — venous thrombosis. Late postoperative complications are mainly represented by the development of heterotopic ossification, post-traumatic coxarthrosis, less often revealed aseptic necrosis of the femoral head, residual protrusion and secondary femoral head lesion. Conclusion. The main approach to the acetabulum are the ileo-inguinal and the Kocher-Langenbeck approach, as well as their combination.Complications were more common using two approaches, especially in cases of simultaneous use. The main intraoperative complications are the sciatic nerve and the superior gluteal artery injury with posterior approaches, the femoral lateral cutaneous nerve with expanded ilio-femoral approach, and the obturator nerve with anterior approaches.

Yoğun Bakım Ünitemizde Perkütan Yöntemle Açılan Trakeostomi Deneyimlerimiz; Retrospektif Analiz

Background: To retrospectively evaluate 58 patients who underwent percutaneous tracheostomy in our intensive care unit.Materials and Methods: The study included 58 patients that underwent percutaneous tracheostomy in the ICU at our Anesthesiology and Reanimation department between January 2017 and December 2020.Results: The percutaneous tracheostomy group comprised 33 (56.9%) men and 25 (43.1%) women with a mean age of 65±18.2 (range, 19-90) years. Most common primary diagnosis of hospitalization was neurological disorders (51.7%). Mean APACHE II score was 23.2±3.6, mean time to percutaneous tracheostomy was 18.3±5.1 (range, 7-30) days, mean procedural time was 11.1±2.4 min, mean duration of mechanical ventilation was 62.1±37.8 (range, 15-167) days, mean intensive care unit stay was 67.2±43.5 (range, 15-247) days, and mean hospitalization time was 77.5±50.4 (range, 15-277) days. Hypoxia and hypotension were the most common intraoperative complications and minor bleeding was the most common postoperative complication.Conclusions: Performing early tracheostomy in intensive care unit patients requiring prolonged mechanical ventilation increases patient comfort, facilitates discontinuation of mechanical ventilation, reduces the dead space, facilitates the clearing of airway secretions, and shortens the duration of intensive care unit and hospital stay. Additionally, percutaneous tracheostomy was revealed as a safe procedure for intensive care unit patients due to its lower complication rates.

Open Cholecystectomy in Respiratory and Cardiovascular disease patients under Lumbar combined Spinal-Epidural Anesthesia

Background and Aims: Regional anesthesia gained popularity over the last three decades due to the technical advances across subdisciplines, better understanding of the physiology, the advances in the field of anesthetic drugs, and the better approach in training for such techniques. The technique is currently used in many anatomical levels and most surgical procedures can be performed using the combined spinal epidural type. The aim of this study is to evaluate the feasibility of the combined spinal-epidural anesthesia in patients with respiratory and cardiovascular diseases who underwent open cholecystectomy.  Patients and methods: This prospective cross sectional study which was done on patients undergoing elective open cholecystectomy (n=119) for whom the general anesthesia was contraindicated due to major cardiovascular and pulmonary diseases, under lumber combined spinal-epidural anesthesia. Results: The mean age of our patients was 64.33(SD: 12.085) years; females constituted 73 of them (61.3%) and males 46 (38.7%). Most patients (73) were complaining from the cardiovascular diseases (61.34%). In most patients the onset of the action of the anesthesia was between 10-12 minutes. In 55 patients (46.2%) no extra-drugs were required, and in the rest of patients intravenous mediations were given to relieve anxiety, pain, or both. In 81 patients (68.1%) no intraoperative complications were reported, the most common intraoperative complication was hypotension in 31 patients (26.1%), post-operatively no complications were reported in 86 patients (72%), and hypotension was reported in 12 patients (10.1%), nausea & vomiting in 11 patients (9.2%). The surgeon’s satisfaction was excellent in 73.11% of the surgeries, as was good in 23.53%. Most patients gained the lower limb movement within 2 hours. There was a significant correlation between the need for extra drugs and both comorbid diseases and the development of intraoperative complications (P values 0.022 & 0.000) respectively and no significant correlations with other parameters such as the gender, postoperative complications and the surgeon’s satisfaction (P values 0.707, 0.522, and 0.056) respectively. Conclusion: The technique of the combined spinal epidural anesthesia is safe and very effective when used for American Society of Anesthesiologist (ASA) patient classification class III and IV patients who need open cholecystectomy. This technique should be used by expert anesthetists who are well trained and gained skill in this technique, and it may be used in fields other than surgery such as trauma victims and for cancer patients.  

A Variant of Micro-Invasive Glaucoma Surgery: Calibrated Reverse Meridional Cyclodialysis ab interno Involving Implantation of a Non-Absorbable Collagen Implant

Purpose. To assess safety and effectiveness of calibrated cyclodialysis ab interno involving implantation of a non-absorbable collagen implant in the suprauveal space in decreasing IOP in glaucoma patients.Methods. Forty-three patients (43 eyes; 16 male and 27 females; average age — 70.4 ± 10.0 years) were included in this pilot study. A 6 mm long and 2.0 mm wide cyclodialysis cleft was created ab interno in one of the lower quadrants of the eye using a specially designed spatula followed by insertion of a strip of implant in the cleft. In 19 eyes (44.3 %) the procedure was performed as standalone procedure and in 24 eyes (55.7 %) along with cataract surgery. Outcome measures were IOP change, use of hypotensive medication(s), complications, and need for a second surgery. Decrease in IOP by >20 % and IOP between 6 and 21 mmHg without hypotensive medication(s) constituted complete success; similar changes in IOP with medication(s) constituted partial success. Need for second surgery constituted failure.Results. At 6 months, baseline IOP decreased from 20.6 ± 7.4 mmHg to 12.9 ± 4.9 mmHg (a decrease by 37.4 %; р < 0.001) and hypotensive medication use reduced from 2.6 ± 0.8 to 1.0 ± 1.1 (a reduction by 57.7 %; р < 0.001). Complete success was achieved in 19 eyes (44.2 %), partial in — 15 eyes (34.9 %). Nine eyes had unsuccessful outcomes (20.9 %); among these, seven eyes (78 %) had severe glaucoma and five eyes (55 %) had undergone previously glaucoma surgeries. Hemorrhaging at the cleft site was the most common intraoperative complication — 18 eyes (41.9 %). Postoperative complications included hyphema, which was completely resorbed within one week.Conclusion. Calibrated cyclodialysis ab interno procedure involving implantation of a non-absorbable collagen implant in the suprauveal is safe and easy to perform. It effectively decreases IOP in patients with moderate glaucoma but is less effective in patients with severe glaucoma and in patients with previously failed glaucoma surgeries. Complications were found to be minimal.

Analysis of clinical factors associated with intraoperative and postoperative complications of retrograde intrarenal surgery.

The aim of this study was to evaluate the factors affecting intraoperative and postoperative complications in retrograde intrarenal surgery. In this retrospective cohort study, 706 retrograde intrarenal surgery procedures administered to 617 patients were reviewed. Intraoperative and postoperative complications were classified according to the modified Satava and modified Clavien classification systems. The stone-free rate was 407 (57.6%) and the success rate was 528 (74.8%). Intraoperative complications were observed in 215 (30.5%) patients. The most common intraoperative complication was mild bleeding 60(8.5%), while the only independent risk factor associated with intraoperative complications was the presence of residual stones. Postoperative complications were observed in 190 (26.9%) patients. The most common postoperative complication was fever requiring antipyretic drugs 60(8.6%), while independent risk factors associated with postoperative complications were the presence of residual stones and solitary kidney.

Cholecystectomy with Thoracic Epidural Anesthesia in Geriatric Patients.

To determine the outcome of thoracic epidural anaesthesia in open cholecystectomy procedures of comorbid advanced elderly patients. Observational study. Faculty of Medicine, Karadeniz Technical University Hospital, Trabzon, Turkey during 2014-2019. This study included 103 geriatric patients of over 65 years, who underwent open cholecystectomy under thoracic epidural anaesthesia during the study period. Patient files, anaesthesia registration forms, early postoperative follow-up, and discharge process were retrospective. The mean age of the patients included in the study was 79.42 ± 9.03 years, while the mean operation time was 68.02 ± 17.44 minutes. While only 7 (6.8%) patients had a chronic disease, the number of patients with two or three comorbid diseases was 67 (65%). The number of patients with 4 or more comorbidities was 29 (28.2%). The most common intraoperative complications were hypotension (n = 22, 21.4%) and bradycardia (n = 19, 18.4%). Intraoperative desaturation was observed in 7 (6.8%) patients; and oxygen and bronchodilator therapy was effective. The median discharge time was 6.5 (5.0-8.25) days; whereas, 5 (4.9%) patients died postoperatively. In open cholecystectomy operations on comorbid advanced elderly patients, thoracic epidural anaesthesia can be preferred to general anaesthesia. Key Words: Geriatrics, Cholecystectomy, Anesthesia, Thoracic epidural, Comorbidity.

Methods of prevention and elimination of the most frequent intraoperative and postoperative complications in the surgical treatment of pulmonary and pleural tuberculosis using video-assisted surgical interventions

Objective — to identify and analyze methods of prevention and elimination of the most common intraoperative and postoperative complications in the surgical treatment of pulmonary tuberculosis and pleura using VATS.
 Materials and methods. In the Department of Thoracic Surgery and Invasive Diagnostic Methods of the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine for the period from 2008 to 2019 performed 169 VATS operations on patients with tuberculosis surgery, of which: 130 (79.3 ± 3.2) % VATS lung resections; 35 (20.7 ± 3.1) % VATS pleurectomy with decortication (PE with DC) of the lung; 4 (2.4 ± 1.2) % of patients underwent other VATS interventions.
 Results and discussions. The level of intraoperative complications among all 169 operated patients was recorded in 9 (5.3 %) cases. Postoperative complications were detected in 29 (17.1 %) patients.Methods of prevention of complications in VATS are the selection of patients at the preoperative stage, correction of hemostasis, safe areas of thoracoport and minitracotomy, lymph dissection, separate treatment of lung root elements, conversion to thoracotomy.
 Conclusions. VATS interventions are minimally invasive, effective and convenient methods of surgical treatment of patients with pulmonary and pleural tuberculosis. Adequate assessment of the possibility of performing VATS, methods of prevention of complications and their timely application provides a predictable course of the postoperative period and reduces the number of complications. Diagnosis of complications and timely use of various methods of their elimination allows you to effectively and reliably apply medical manipulations to resolve both intra­ and postoperative complications in this type of surgery. Understanding and using methods of prevention and elimination of complications, allows to determine the correct tactics of operation and management of the postoperative period.

Efficacy, safety and visual outcomes of cataract surgeries performed during blindness prevention programs in different locations in Kenya.

To determine the visual outcomes achieved in terms of efficacy and safety during high-volume cataract surgery programs in different locations in Kenya. Eight hundred eighty-one eyes of 849 patients underwent extracapsular cataract extraction with intraocular lens implantation in a retrospective, observational, consecutive cohort study on patients who underwent cataract surgery in five programs that a Spanish non-governmental organization conducted between 2013 and 2019 for the prevention of blindness in different geographical areas of Kenya: Thika, Athi River, Kissi, Bagavathi, and Nakuru. The programs were carried out by Spanish and Kenyan surgeons working together. Mean age was 66.81 ± 14.47 years. Fifty-one percent of the operated eyes (447 eyes) were women. 94% of patients belonged to six ethnic groups. The mean uncorrected distance visual acuity (UDVA) before surgery was 1.98 ± 0.98 logMAR (20/2000), which changed to 0.82 ± 0.68 logMAR (20/150) 3 months after surgeries. The corrected distance visual acuity (CDVA) was 0.4 ± 0.53 logMAR (20/50) 3 months after surgery, 77.5% of the patients had good visual outcomes, and 6.3% had poor outcomes. Preoperative UDVAs were significantly different with respect to the different geographical areas (Kruskal-Wallis; p < 0.001). The most common intraoperative complication was posterior capsule rupture (incidence, 4.2%, 37 of 881), and the most serious complication was expulsive hemorrhage (incidence, 0.1%, 1 of 881). Cataract programs performed in a middle-income country with the proper technique and standardized protocols of action improved the visual outcome of the patients. Dissimilar baseline status was found in different areas regarding preoperative visual acuities. Training programs of local surgeons should be reinforced.

Scoliosis in Children: Impact of Goal-Directed Therapies on Intraoperative and Postoperative Outcomes

Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery, where blood loss, transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and presented here. Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement and implementation measures. Methods: A secondary analysis of patients undergoing scoliosis surgery from 1 January 2014 to 17 May 2017 was undertaken in our institution—Necker Enfants Malades university hospital. The study was approved by the Ethics Committee. Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and/or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in 1 patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in 3 patients (2.6%), and abdominal sepsis and septicemia in 2 patients (1.7%). 12 patients (10.3%) had reoperations. Fifty-six patients (48.3%) had intraoperative transfusion. There was no in-hospital mortality. Conclusion: The portion of patients with intraoperative and or postoperative complications was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.

Profile of intraoperative complications in cataract surgery SEHEDS: Sitapur eye hospital eye disease study

Background: Over the past several decades there have been many advances in the equipment, instrumentation and techniques of performing cataract surgery. This article will address the profile of intraoperative complications in cataract surgery.Methods: In this retrospective study all cataract procedures performed (n=18775) during the two years period (i.e. 2017 and 2018) were analysed and total 1401 (7.46%) valid cases (those having complications) were seen with 686 (49.0%) and 715 (51.0%) cases in the year 2017 and 2018 respectively. The age, gender, and side of the eye operated on were noted. The yearly incidence of the profile of complications was analysed. Results: Out of the total 1401 cases of eventful cataract surgery majority of the cases were of the age range of 51-70 years 1140 (6.07%) males were slightly higher in number i.e. 710 (3.78%) whereas females were 691 (3.68%), right eye was majorly operated for cataract i.e. 760 (4.05%). Manual small incision cataract surgery (MSICS) was done in the majority of the patients followed by phaco. The patients faced the complications due to cataract surgery in which posterior capsular rent- vitreous disturbance was the major complication occurred in majority of the patients 965 (5.15%). Conclusions: Patients who underwent eventful cataract surgery the most common intra-operative complications which were mainly posterior capsular rent- with vitreous disturbance and iridodialysis. Patients with higher risk factor should be identified and appropriate measures must be taken to minimize intraoperative complications to get better visual outcomes.

PREVENTION OF INTRAOPERATIVE COMPLICATIONS IN PATIENTS WITH ACUTE AORTIC SYNDROME

Among the methods of treatment of acute aortic pathology in many cases, the surgery remains the method of choice. In order to improve the results of treatment for the patients with acute aortic syndrome by reducing the number of acute intraoperative lesions of organs and systems, a study was conducted, wherein there were analyzed the results of surgical treatment of 166 patients with thoracic and / or abdominal aortic lesions. The advantages of the developed and implemented in practice diagnostic and treatment algorithm for such patients in the pre−, intra− and postoperative periods have been considered. Upon admission to clinic, the main tasks were the maximum elucidation of the diagnosis and rapid structuring of surgery, which were started as soon as possible, primarily to control the blood loss. Hardware reinfusion of all blood lost from aortic rupture was mandatory. The most significant systemic complications were determined by cardiac, renal, respiratory and neurological ones. The proposed diagnostic and treatment algorithm has been concluded to be able of reducing the time and increase of the care efficiency for this category of patients. Programmed and systematic prevention of the most common and most dangerous intraoperative complications of acute aortic syndrome prevents their occurrence, reduces severity, improves the treatment outcomes. Intraoperative autohemotransfusion can reduce the total volume of blood loss, volume of infusion of donor drugs, and, consequently, frequency of acute kidney and lung injury in the intra− and early postoperative periods. The overall results of treatment for the patients with acute aortic syndrome largely depend on the experience of medical staff and equipment of a specialized hospital. Key words: aorta, acute aortic syndrome, aortic aneurysm, aortic dissection, surgical treatment, autohemotransfusion.

Surgical and visual outcome of posterior polar cataract

Purpose: To evaluate the surgical and visual outcome of manual small incision cataract surgery in patients with posterior polar cataract. Material and Methods:A prospective study was conducted from June 2018 to August 2018. 26 eyes of 26 patients underwent surgery at our hospital were included in our study. All patients underwent complete ophthalmologic examination which included visual acuity, slit-lamp biomicroscopy, IOP and fundoscopy. Patients with complicated cataract, glaucoma, corneal opacity/ degeneration, retinal pathology were excluded. Patients were scheduled for manual SICS. Informed consent was obtained from all the patients. Results:26 eyes of 26 patients were included in the study. There were 19 males (73.07%) and 7 females (26.92%). The mean age was 53.5 (range 37-70) years. The most common intraoperative complication was posterior capsule rupture, seen in 3 eyes (11.53%). The intraocular lenses were implanted in the sulcus in those 3 patients and rest in the bag implantation was done.1 eye needed anterior vitrectomy. The mean visual acuity improved significantly after surgery. Conclusion: Posterior polar cataract is a great challenge for cataract surgeons. The visual outcome is good if done carefully with proper technique advised for PPC. Keyword:PPC, PCR, Vitrectomy