Common Intraoperative Complication Research Articles

Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery\u2014a retrospective, cross-sectional long-term analysis

ObjectivesThe aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery.Materials and MethodsIn a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0–4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients.ResultsBad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients’ self-perception (85.4%), with 60.4% of patients opting for surgery again.ConclusionsLong-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education.Clinical relevanceHypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.

Ligation of the Maxillary Artery Prior to Caudal Maxillectomy in the Dog-A Description of the Technique, Retrospective Evaluation of Blood Loss, and Cadaveric Evaluation of Maxillary Artery Anatomy.

Two different surgical techniques have been described for performing caudal maxillectomies in dogs including the intraoral (IO) and combined dorsolateral and intraoral (DL-IO) approach. Hemorrhage is the most common intraoperative complication reported during these procedures as maxillary arterial ligation is not performed until after all osteotomies and mobilization of tumor-bearing bone. The objectives of this study were to describe a modified approach for caudal maxillectomy in the dog involving preligation of the maxillary artery, to retrospectively evaluate the ability of this modified approach to limit hemorrhage in a cohort of 22 dogs, and to clarify the vascular anatomy of the maxillary artery and its branches in relation to associated nerves. Medical records were retrospectively reviewed for cases that had caudal maxillectomy via a combined approach (with or without preligation of the maxillary artery) from January 1, 2004 to December 31, 2019. Twenty-two cases were identified, six without, and 16 with arterial preligation, respectively. Osteotomies were completed with a high-speed handpiece and rotary bur (n = 18), or oscillating bone saw (n = 4). All six (100%) dogs in the traditional DL-IO group developed hypotension under general anesthesia. Four (67%) of these required intraoperative blood transfusions, one of which required an additional postoperative blood transfusion. In contrast, only one of 16 (6%) dogs in the modified DL-IO group required an intraoperative blood transfusion, and only three (19%) developed hypotension. Moreover, a significant association was detected between postoperative PCV and the two different surgical approaches (P = 0.021). These results demonstrate the effectiveness of preligation of the maxillary artery in preventing hemorrhage in caudal maxillectomies in dogs and this represents an improvement in outcome over previously reported studies. Decreased intraoperative hemorrhage may improve surgical exposure and decrease overall patient morbidity.

Outcomes of simultaneous vs. sequential pars plana vitrectomy and cataract surgery.

The coexistence of cataract and vitreoretinal diseases is common in clinical practice. The technological achievements of the last decade in both types of surgeries, allow simultaneous interventions on lens and retina. This retrospective study assessed the morphofunctional results obtained after performing simultaneous surgeries in a series of 87 patients presenting with both pathologies. The cases were retrospectively reviewed from their clinical records from 2017 to 2019. The patients were divided into two groups: group 1 comprising 41 cases underwent the combined procedure and group 2 comprising 46 patients underwent vitrectomy, followed by cataract surgery after 3-10 months. The functional and anatomical outcomes and the complications were assessed pre- and post-operatively. The statistical analysis was carried out by MaxStat software. The final best corrected visual acuity (BCVA), in group 1 was <0.1 in 4.88% of the cases, 0.1 to 0.3 in 17.07%, 0.3 to 0.5 in 51.22% and >0.5 in 26.83% eyes. In group 2, the final BCVA, after both surgeries were completed was <0.1 in 8.7% cases, 0.1 to 0.3 in 30.43%, 41.3% were 0.3 to 0.5 and 19.57% were >0.5. During the cataract surgery, the most common intraoperative complication was miosis, followed by posterior capsule rupture. Postoperative, 12.2% cases from group 1 developed an immediate inflammatory reaction in the anterior chamber, and 17.07% presented with posterior capsular opacification (PCO). Simultaneous surgery is safe and effective in obtaining a good morphological and functional result and offers the advantage of a clear eye media that allows a safer vitrectomy and thus a quicker rehabilitation of the patient. The analysis of the risks and benefits of each procedure should be taken into account and the cases selected individually for either simultaneous or sequential surgery in order to obtain the best outcomes.

A comparative study between intravenous Ondansetron and Granisetron in attenuation of hypotension during spinal anaesthesia in patients undergoing caesarean section

Hypotension is most common intraoperative complication after spinal anesthesia during cesarean delivery. The Bezold–Jarisch reflex is one of the causes for occurrence of hypotension after spinal anesthesia through serotonin with decreased blood volume. Our aim of this study was to compare the two serotonin receptor antagonists Ondansetron and Granisetron to prevent spinal induced hypotension and bradycardia after spinal anesthesia in parturients undergoing cesarean sections. 90 patients of ASA class-I and II, aged 20-40years, weight 40-80kilograms were included in this study. Patient with history of PIH, convulsion, any major comorbidity were excluded from study. Patients were assigned into 3 groups group A received 4 mg Ondansetron intravenously, group B received 1 mg Granisetron intravenously and group C received 10 ml of intravenous normal saline 5 min before spinal anaesthesia. The difference in mean was analyzed using post hoc Bonferroni test and ANOVA test. The difference in proportions was analyzed by using chi-square test. SBP, DBP and MBP were statistically lower in both Granisetron and Saline group as compared to Ondansetron group at most of the times after drug administration. Heart rate and shivering were comparable in the three groups. Nausea and vomiting was statistically more in saline group as compared to other groups. Use of ephedrine was also significantly more in saline group (37%). 4mg intravenous Ondansetron prior to spinal anaesthesia in LSCS patients reduces the incidence of hypotension, bradycardia and need of vasopressor. Granisetron had no effect on haemodynamic parameters.

258. Exploring perioperative complications of anterior lumber interbody fusion in patients with a history of prior abdominal surgery: a retrospective cohort study

258. Exploring perioperative complications of anterior lumber interbody fusion in patients with a history of prior abdominal surgery: a retrospective cohort study

Intra-operative and Immediate Post-operative Complications in a High Volume Cataract Surgery Center

Purpose: To find out the frequency of complications in a high volume phacoemulsification set up at a tertiary care eye hospital in Lahore.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Al-Ehsan Eye Hospital, Lahore, from July 2017 to June 2019.&#x0D; Methods: Surgical outcomes of 6902 patients who had undergone phacoemulsification were included. Patients were excluded if they had ocular infections, lid margin diseases, adnexal diseases, those requiring a secondary anterior chamber surgery and those unfit for the procedure due to medical grounds. Every patient underwent a detailed history and complete clinical examination. All patients underwent the standard phacoemulsification technique and at the end of each surgery, subconjunctival injections of dexamethasone and gentamycin were given to the patients. Complications encountered during high volume cataract surgery were recorded and their percentages were calculated.&#x0D; Results: A total of 6902 patients underwent cataract surgery with 2.66% intra-operative and 6.94% immediate post-operative complications. The most common intra-operative complication was posterior capsular rupture (1.15%). In patients with capsular rupture the intra ocular lens was implanted within the sulcus in 61 cases (0.88%) while in 12 cases (0.17%) anterior chamber lens was implanted because of lack of capsular support. During the surgery intra ocular lens could not be implanted in 7 cases (0.10%) and they were left aphakic. The commonest immediate post-operative adverse outcome was corneal edema with striate keratopathy and decements folds in 197 cases (2.85%).&#x0D; Conclusion: High volume cataract surgery using appropriate techniques and sterilization does not compromise the quality of outcomes.&#x0D; Key Words: Cataract, Phacoemulsification, Vitreous loss.

Complications after male adjustable suburethral sling implantation.

IntroductionArgus suburethral sling implantation is a minimally invasive operation with the possibility to adjust the tension of the sling at any time after the procedure, which provides good treatment results for male stress urinary incontinence (SUI).AimTo determine the predictive factors, the incidence, severity and timing of the onset of complications after Argus sling implantation for males with post-operative SUI.Material and methodsA total of 41 patients who underwent Argus sling implantation due to post-operative SUI were included. Median follow-up was 12 months. All complications were captured and graded according to severity and classified by timing of onset. Logistic regression analysis was performed to identify predictors of the most common side effects.ResultsOverall 22 (54%) of 41 males have experienced 31 complications. Three (7%) patients have experienced only intra-operative, 16 (39%) patients only post-operative and 3 (7%) patients both intra-operative and post-operative complications. The most common intra-operative complications were bladder perforation (12%) and external iliac vein injury (5%), while post-operative complications were acute urinary retention (29%), infection (10%) and perineal pain (7%). Previous radiotherapy has significantly increased the risk of intra-operative complications, while a non-significant tendency was observed for younger age, previous androgen deprivation therapy and grade 3 SUI. In terms of severity, most post-operative complications were classified as grade 3 according to the modified Clavien-Dindo system.ConclusionsArgus sling implantation provides a tolerable complication rate, where acute urinary retention was the most common side effect. Previous radiotherapy significantly increases the risk of serious intra-operative complications.

What Should be Done for Perforation of the Gallbladder During Laparoscopic Cholecystectomy: Prophylaxis or Treatment?

Background: Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy (LC) is one of the most common intraoperative complications, and there is no clear consensus among surgeons on this issue and there are studies reporting the antibiotic treatment. The aim of this study is to determine the effect of type and duration of antibiotic use on infective complications between iatrogenic perforations of the gallbladder during LC patients. Methods: Patients who developed iatrogenic perforation of gallbladder during LC were subdivided into three groups according to antibiotic treatment; single dose intravenous (i.v.) antibiotic group, prophylactic antibiotic + additional dose i.v. antibiotic group, and prophylaxis + additional dose i.v. antibiotic + oral antibiotic group. Results: A total of 577 patients who underwent LC were included in the study, and 114 patients (19.8%) had iatrogenic perforation of gallbladder. No statistically significant difference was found in wound infection and surgical site infection in all three groups (P > .05). Conclusions: We suggest that single dose antibiotic use is sufficient to prevent infectious complications in patients who had iatrogenic perforation of the gallbladder during LC. Adding intravenous and/or oral antibiotics does not contribute to prevention of infective complications in these patients.

COMPARATIVE STUDY BETWEEN THE USE OF AMNIOTIC MEMBRANE AND FIBRIN GLUE FOR THE REPAIR OF PERFORATED MAXILLARY SINUS (AN EXPERIMENTAL STUDY)

Introduction: Maxillary sinus membrane perforation is the most common intraoperative complications associated with the sinus lifting procedure. There are various sutureless techniques used in repairing of perforated sinus membrane including; collagen membrane, fibrin sealants, cyanoacrylate adhesives,amniotic membrane and fibringlue. Objectives: The aim of this study was to compare between the use of amniotic membrane and fibrin glue in healing of perforated maxillary sinus in rabbits. MATERIALS AND METHOD: This study was conducted on ten adult healthy male rabbits, with an average weight between 2-3 kgs. A split mouth design was implemented. In each rabbit, the right sinus membrane window was repaired by fibrin glue (group I), while the left sinus membrane window was repaired by amniotic membrane (group II). Results: Histological results revealed that amniotic membrane enhanced faster reepithelialization of maxillary sinus membrane and bone healing where the amount of the newly formed bone observed in group II was greater than that of group I. Histomorphometric analysis showed the increase in the bone surface area mean percentage in group II in comparison to group I. Conclusion: According to the results of the present study, it was concluded that the amniotic membrane is effective in the repair of perforated sinus membrane with superior potentiality than fibrin glue especially in the early stage.

Intra-Operative and Immediate Post-Operative Complications of Cataract Surgery in an Eye Camp

Purpose: To analyze the intra-operative and immediate post-operative complications in patients after cataractsurgery in an eye camp.Study Design: Descriptive cross-sectional study.Place and Duration of Study: The study was conducted in a village of Nawabshah, Sindh, Pakistan from 7th to9th of February 2020.Material and Methods: Fifteen hundred patients were screened for visual disabilities of which 150 were selectedfor the study. They had a visual acuity of less than 6/9 in one or both eyes and had a cataract. The selectedpatients were operated using either phacoemulsification, extracapsular cataract extraction ECCE), intracapsularcataract extraction (ICCE) or small incision cataract surgery (SICS). The immediate intra-operative as well aspost-operative complications on day 1 after surgery were observed.Results: One hundred and fifty patients were operated. Age ranged from 14 years to 90 years, males were58.7% and females were 41.3%. The most common procedure performed was phacoemulsification 51.3%,followed by ECCE 30.0%, then SICS 18.0% and ICCE 0.7%. The most common intra-operative complication wasposterior capsule rent and the most common post-operative complication was striate keratopathy which was seenin 14.0% individuals. There was a significant association found for post-operative complications with gender withfemales having more post-operative complications as compared to males (P-value = 0.001 &lt; 0.001).Conclusion: Camp surgeries when performed with strict sterilization and in experienced hands can play animportant role in treating cataract, which is the commonest cause of preventable blindness in developingcountries

Exploring perioperative complications of anterior lumber interbody fusion in patients with a history of prior abdominal surgery: A retrospective cohort study

BACKGROUND CONTEXTAnterior lumbar interbody fusion (ALIF) exposes the anterior aspect of the spine through a retroperitoneal approach. Access to the anterior spine requires mobilization of intra-abdominal viscera/vasculature, which can become complicated as scarring and/or adhesions develop from prior abdominal surgical interventions, increasing risk of intraoperative complications. The literature suggests that “significant prior abdominal surgery” is a relative contraindication of ALIF surgery; however, there is no consensus within the literature as to what defines “major/significant” abdominal surgeries. Additionally, the association between the number of prior abdominal surgeries and perioperative complications in ALIF surgery has not been explored within the literature. PURPOSEThis study seeks to explore the association between perioperative complications of ALIF surgery and the type (major and/or minor) and number of prior abdominal surgeries. DESIGNA retrospective cohort study was performed to examine perioperative complications in ALIF patients with or without prior history of abdominal surgery. PATIENT SAMPLEAll consecutive patients undergoing ALIF with or without a history of prior abdominal surgery from 2008 to 2018 at a single tertiary center were evaluated. Patients under the age of 18, patients with spinal malignancy, or patients who had ALIF above L3 were excluded. OUTCOME MEASURESPerioperative complications included intraoperative complications during ALIF surgery and postoperative complications within 90 days of ALIF surgery. Intraoperative complications include vascular injury, ureter injury, retroperitoneal hematoma, etc. Postoperative complications include urinary tract infection, revision of abdominal scar, ileus, deep vein thrombosis, pulmonary embolism, etc. Other outcome measures include readmission within 90 days, length of ALIF surgery, and length of hospital stay. METHODSElectronic medical records of 660 patients who underwent ALIF between 2008 and 2018 were retrospectively reviewed. Patient demographics, Charleston Comorbidity Index (CCI), level of fusion, past abdominal surgical history, use of access surgeon during exposure, intraoperative, and postoperative complications were collected. Predictors of intraoperative and postoperative complications were analyzed using simple and multivariable logistic regression. Statistical analysis was performed using JMP 14.0 (SAS, Cary, NC, USA) software. RESULTSAfter controlling for age, length of ALIF, gender, multilevel ALIF, and the use of an access surgeon, there was no significant association between the type of prior abdominal surgery (major and/or minor) and intraoperative complications on multivariable logistic regression analysis (Minor: odds ratio [OR]=1.68; 95% confidence interval [CI]: 0.58–4.86 & Major: OR=1.99; 95% CI: 0.80–4.91). On multivariable logistic regression, the odds of developing an intraoperative complication increases by 52% for each additional prior abdominal surgery after adjusting for age, length of ALIF, gender, multilevel ALIF, and the use of an access surgeon (OR=1.52, 95% CI: 1.10–2.11). Iliac vein laceration was the most common intraoperative complication (n=27, 4%). Neither the type (major and/or minor) nor the number of prior abdominal surgeries were significant predictors of postoperative complications (Minor: OR=1.29; 95% CI: .72–2.31, Major: OR=1.24; 95% CI: 0.77–2.00, & Number: OR=1.03; 95% CI: .84–1.26). CONCLUSIONWith each additional prior abdominal surgery, accumulation of scarring and adhesions can likely obscure anatomical landmarks and increase the risk of developing an intraoperative complication. Therefore, the number of prior abdominal surgeries should be taken into consideration during planning and operative exposure of the anterior spine via a retroperitoneal approach.

Posterior Capsular Tear

Cataract surgery is one of the most performed ocular surgeries. It is normally a safe procedure to have. Cataract surgery needs good training for the junior surgeon to master the technique and avoid the common intraoperative complication. One of the most common and dreadful complications of cataract surgery is posterior capsular tear.

Efficacy and safety of percutaneous ultrasound-guided microwave ablation for cervical metastatic lymph nodes from papillary thyroid carcinoma

Purpose Our purpose is to assess the efficacy and safety of percutaneous US-guided microwave ablation (MWA) for cervical metastatic lymph nodes from papillary thyroid carcinomas (PTC). Methods In total, 37 patients with 98 cervical metastatic lymph nodes from PTC were enrolled in this retrospective study. Among them, 8 had subtotal thyroidectomy, 4 lobectomy, 2 no operation, and the rest total thyroidectomy. A multipoint and multiplane fixed ablation method was used. Monitoring of ablation process and clinical follow-up consisted of US or CEUS. Results All 98 metastatic lymph nodes successfully treated in a single session with 100% complete ablation. The average longest and shortest diameter of the tumors were reduced from 13.21 ± 5.86 mm to 6.74 ± 5.66 mm (p =.00) and from 9.29 ± 4.09 mm to 4.31 ± 3.56 mm (p =.00) at the final follow-up. There were no evidence of recurrence at ablated sites. The common intraoperative complications were a burning sensation and pain. Only 3 patients had vagal reflex. Conclusions US-guided MWA can effectively control cervical metastatic lymph nodes from PTC. MWA may become an alternative therapy in selected PTC patients with cervical lymph node metastasis.

Natural language processing for automated detection of incidental durotomy

BACKGROUNDIncidental durotomy is a common intraoperative complication during spine surgery with potential implications for postoperative recovery, patient-reported outcomes, length of stay, and costs. To our knowledge, there are no processes available for automated surveillance of incidental durotomy. PURPOSEThe purpose of this study was to develop natural language processing (NLP) algorithms for automated detection of incidental durotomies in free-text operative notes of patients undergoing lumbar spine surgery. PATIENT SAMPLEAdult patients 18 years or older undergoing lumbar spine surgery between January 1, 2000 and June 31, 2018 at two academic and three community medical centers. OUTCOME MEASURESThe primary outcome was defined as intraoperative durotomy recorded in free-text operative notes. METHODSAn 80:20 stratified split was undertaken to create training and testing populations. An extreme gradient-boosting NLP algorithm was developed to detect incidental durotomy. Discrimination was assessed via area under receiver-operating curve (AUC-ROC), precision-recall curve, and Brier score. Performance of this algorithm was compared with current procedural terminology (CPT) and international classification of diseases (ICD) codes for durotomy. RESULTSOverall, 1,000 patients were included in the study and 93 (9.3%) had a recorded incidental durotomy in the free-text operative report. In the independent testing set (n=200) not used for model development, the NLP algorithm achieved AUC-ROC of 0.99 for detection of durotomy. In comparison, the CPT/ICD codes had AUC-ROC of 0.64. In the testing set, the NLP algorithm detected 16 of 18 patients with incidental durotomy (sensitivity 0.89) whereas the CPT and ICD codes detected 5 of 18 (sensitivity 0.28). At a threshold of 0.05, the NLP algorithm had specificity of 0.99, positive predictive value of 0.89, and negative predictive value of 0.99. CONCLUSIONSInternal validation of the NLP algorithm developed in this study indicates promising results for future NLP applications in spine surgery. Pending external validation, the NLP algorithm developed in this study may be used by entities including national spine registries or hospital quality and safety departments to automate tracking of incidental durotomies.

Intraoperative aneurysm rupture — the main complication in microsurgery of cerebral aneurysms

Objective: To analyze the impact of the intraoperative risk factors of intraoperative aneurysm rupture (IAR) and IRA in clipping a brain aneurysm on the results of surgical treatment.Materials and methods. A retrospective analysis of surgical treatment of 138 (11.4 %) patients, with IAR during clipping of a brain aneurysm in the period from 2011 to 2017, was performed. The total number of operations for clipping cerebral aneurysms in our observations is 1,208 (100 %). Preoperative examination of patients included clinical and neurological examination, brain CT, cerebral angiography (CAG), duplex scan of the main vessels of the head and neck. The radicality of clipping was controlled by puncture of the aneurysmal dome, using intraoperative Doppler and postoperative CAG.Results. IAR occurred at all stages of surgery preceding the exclusion of an aneurysm from the bloodstream, but prevailed in its isolation and clipping. Non-contact arterial aneurysm (AA) rupture was observed in 6 (4.35 %) patients. Ischemic lesions according to postoperative MSCT of the brain were observed in 2 (1.45 %) patients with noncontact intraoperative ruptures of AA MCA on the right. The contact intraoperative rupture of AA was observed in 132 (95.65 %) cases. The results of treatment were evaluated at hospital discharge on the Glasgow scale results, according to which we received the following data: 5 points — 67 patients (48.55 %); 4 points — 17 (12.32 %); 3 points — 37 (26.81 %); 2 points — 0; 1 point — 17 (12.32 %) cases.Conclusions:1. Intraoperative rupture brain aneurysm is the most common intraoperative complication, which threatens massive blood loss during surgery, forces the surgeon to change surgical tactics and often perform aggressive manipulations, such as forced temporal clipping.2. Analyzing the surgical interventions of clipping of cerebral AA in which IAR took place, the most common risk factors for IAR were found to be brain swelling, large AA, atherosclerotic changes of cerebral vessels, high blood pressure during surgery, pronounced arachnoid changes.3. According to our observations data, most of the IARs occurred with AA of the ACA-ACoA complex (84 cases — 60.87 %), which is related to hemodynamic features, anatomic variability of the ACA-ACoA complex and frequent localization of AA in this area.4. In our study, IAR occurs more frequently at the stage of AA excretion (116 cases — 84.06 %) and directly during AA clipping (7 cases — 5.07 %); less frequently — at the stage of AA artery extraction (6 — 4.35 %), at the stage of early arachnoid dissection (3 — 2.17 %) and at the craniotomy stage — non-contact IAR (6 — 4.35 %).

Age - Does it really count? A study of the Perioperative Morbidity and Long-Term Outcome in Patients Above 70 Years of Age Undergoing Spine surgery for Lumbar Degenerative Disorders.

Objective To assess the long-term outcome and perioperative morbidity in spine surgeries for lumbar degenerative disorders and, thereby, to evaluate the safety of surgery in the aging population. Methods Retrospective study of patients aged > 70 years, operated for degenerative lumbar disorders between 2011 and 2015. We evaluated patient demographic, clinical and surgical data; comorbidities, perioperative complications, pre & postoperative pain scores and Oswestry disability index (ODI) scores, patient satisfaction and overall mortality. Results A total of 103 patients (Males: Females55:48) with mean age 74.6 years (70–85yrs) were studied. 60 patients (58.2%) had decompression alone, while 43 (41.8%) had decompression & fusion. Mean hospital stay was 5.7days. Mean follow-up was 47.6months (24–73mnths). Patients reported significant improvement in backpain (Numerical pain score 7.7 vs 1.6; p < 0.001), leg pain (Numerical pain score 7.4 vs 1.7; p < 0.001), disability (ODI 82.3 vs 19.1; p < 0.001) and walking distance ( p < 0.001). 76% patients were satisfied with the results at the time of final follow-up. 26 patients (25.24%) had perioperative complications which were all minor, without mortality. Most common intraoperative & postoperative complications were dural tear (6.79%) & urinary tract infection (6.79%) respectively. Conclusions With meticulous perioperative care lumbar spine surgery is safe and effective in elderly population. Patients had longer mean hospital stay in view of the gradual and comprehensive rehabilitation program. Presence of comorbidities or minor perioperative complications did not increase the overall morbidity or affect the clinical outcomes of surgery in our study.

Urolithiasis and intracorporeal lithotripsy in 37 Military Hospital, Accra, Ghana.

The purpose of this study was to determine the indications and complications of intracorporeal lithotripsy in our institution. Retrospective study carried out at the urology unit of the 37 Military Hospital between 2012-2015. 42 patients had intracorporeal lithotripsy out of 359 patients who had surgery within the period. Records of all patients who had intracorporeal lithotripsy between December 2012 to December 2015 were collected and analysed. An endourology log sheet was used to record data of patient's name, age, sex, indication for operation, location of stone, intraoperative complications, type of instruments/materials used, stone analysis and follow-up dates. All patients between the ages of six months to seventy years presenting with urinary stones diseases within the period were included, whilst patients with urinary stone disease who were managed with open surgery were excluded.Ethical clearance was obtained from the 37 Military Hospital institutional review board. Lithotripsy constituted 42/359(11.7%) of the methods used in the surgical cases done within the period.The commonest age of presentation was between 31-40 years (26.2%), with a male to female ratio of 2:1. The commonest indications for lithotripsy were pain (92.8%) and hydronephrosis (61.9%). Ureteric stones are more common (50%), followed by renal stones (45%) with the commonest site being the proximal ureter. The commonest procedure was ureteroscopy. Ureteral mucosal injury (5/43) (11.62%), was the commonest intraoperative complication. Postoperative complications were reno-cutaneous fistula (1/43) (2.32%), severe bleeding (1/43) (2.32%) haematuria (4/43) (9.30%). Pain was the commonest indication for intra-corporeal lithotripsy (92.8%) and also the commonest post-operative complication (9.30%). None declared.

Complications and outcomes associated with unilateral thyroidectomy in dogs with naturally occurring thyroid tumors: 156 cases (2003-2015).

To describe complications and outcomes of dogs undergoing unilateral thyroidectomy for the treatment of thyroid tumors. 156 dogs undergoing unilateral thyroidectomy for a naturally occurring thyroid tumor. Dogs that underwent a unilateral thyroidectomy in 2003 through 2015 were included in a multi-institutional retrospective study. For each dog, information gathered through evaluation of electronic and paper records included perioperative complications, short-term outcome (survival to discharge from the hospital vs nonsurvival), and long-term outcome (survival time). In the perioperative period, complications occurred in 31 of the 156 (19.9%) dogs; hemorrhage was the most common intraoperative complication (12 [7.7%] dogs). Five of 156 (3.2%) dogs received a blood transfusion; these 5 dogs were among the 12 dogs that had hemorrhage listed as an intraoperative complication. Immediately after surgery, the most common complication was aspiration pneumonia (5 [3.2%] dogs). One hundred fifty-three of 156 (98.1%) dogs that underwent unilateral thyroidectomy survived to discharge from the hospital. One hundred-thirteen dogs were lost to follow-up; from the available data, the median survival time was 911 days (95% confidence interval, 704 to 1,466 days). Results indicated that unilateral thyroidectomy in dogs with a naturally occurring thyroid tumor was associated with a perioperative mortality rate of 1.9% and a complication rate of 19.9% and that hemorrhage and aspiration pneumonia were the most common complications. Long-term survival of dogs undergoing unilateral thyroidectomy for the treatment of thyroid tumors was not uncommon.

Complicaciones intraoperatorias y posoperatorias de las cintas medio uretrales libres de tensión en incontinencia urinaria de esfuerzo

Antecedentes: La colocación de cintas medio uretral son actualmente el tratamiento de primera línea para la incontinencia urinaria de esfuerzo. El objetivo fue evaluar las complicaciones intra y posoperatorias de las cintas transobturadora y retropúbica; y los factores de riesgo asociados.&#x0D; Material y métodos: Estudio de cohorte retrospectivo en 105 mujeres durante el 2016 a 2018. Se dividió en dos grupos: TVT (n=28) y TOT (n=77). Se analizaron variables demográficas, factores de riesgo, complicaciones intra y posoperatorias. Se realizo estadística descriptiva y correlación de variables con programa SPSS v17.0, y p ≤ 0.05 estadísticamente significativo.&#x0D; Resultados: La edad promedio fue 56.7 ± 8.8 años; 31.4% (n=33) con incontinencia de esfuerzo, 65.7% (n=69) con incontinencia mixta (IUM) y 2.9% (n=3) con incontinencia oculta. La tasa de complicación global fue de 29.5% (n=31). La complicación intraoperatoria común fue la perforación vesical 3.8% en el grupo TVT asociada a obesidad (OR 12.9). Las complicaciones posoperatorias estuvieron relacionadas con la TOT (p=0.049), compuestas por infección de vías urinarias (11.4%), inguinodinea (7.6%) y otras (6.9%). El riesgo de infección urinaria posoperatorio estuvo asociado con incontinencia de esfuerzo (p=0.03), ausencia de tratamiento de incontinencia urinaria mixta (p=0.04); aumentado la tasa de incontinencia urinaria de urgencia de novo.&#x0D; Conclusiones: El enfoque transobturador tiene bajos índices de complicaciones transoperatorias en comparación con la retropúbica. La complicación más común en nuestra serie fue la infección urinaria por lo que se requieren estudios prospectivos aleatorizados.

A Percutaneous Technique to Reposition the Cortical Button of Adjustable-Loop Devices in Anterior Cruciate Ligament Reconstruction

Adjustable-loop devices are relatively new but quite popular and have been routinely used for around a decade in arthroscopic anterior cruciate ligament reconstruction for hamstring graft fixation on the femur. They allow surgeons to adapt to different tunnel lengths, eliminate the need for multiple loop sizes, decrease the “bungee cord effect,” maximize the amount of graft within the femoral socket available for incorporation, and allow retensioning of the graft. Apart from these advantages, certain complications are associated with the use of adjustable-loop devices. When the cortical button is being pulled up through the femoral tunnel, it may be pulled up with greater force, causing it to come out of the vastus lateralis, the iliotibial band, or even the skin. When the graft is pulled back from the tibial side, the cortical button may flip in the substance of the vastus lateralis or outside the iliotibial band. This soft-tissue interposition can cause ischemic necrosis of the interposed tissue, soft-tissue irritation, migration of the cortical button, or early loosening of the graft, leading to anterior cruciate ligament reconstruction failure. We describe a percutaneous solution to this common intraoperative technical complication. The outer sheath of a 4.5-mm arthroscope, 4.5-mm acromionizer, or notchplasty burr can be safely used to put the cortical button back against the lateral cortex of the femur.