Comparison Of Surgical Treatments Research Articles

Comparison of surgical treatments for triple extensor tendon ruptures in rheumatoid hands: A retrospective study of 48 cases

Objective. This retrospective study was designed to evaluate the outcomes of four different surgical reconstructions for extensor tendon ruptures in ulnar three fingers in 48 patients with rheumatoid arthritis.Methods. The following four techniques were performed; palmaris longus tendon grafting (PL group; n = 9), extensor indicis proprius (EIP) tendon transfers (EIP group; n = 8), end-to-side transfers with tension-reduced early mobilization (End-to-side group; n = 16), and a combination of end-to-side and EIP transfers (Combination group; n = 15). Loss of extension was evaluated to determine the mean postoperative range of motion of the metacarpophalangeal (MP) joint and clinical outcomes were categorized using modified Geldmacher criteria.Results. Combination group demonstrated the best mean MP joint extension (− 3°), followed by End-to-side group (− 12°), EIP group (− 16°), and PL group (− 21°). Combination group yielded the best clinical outcomes with all cases showing good results.Conclusions. The combination of end-to-side and EIP transfer was an effective surgical reconstruction procedure for triple fingers extension loss.

OC-082 The results of a multi-centre study of surgery for full thickness rectal prolapse: Abstract OC-082 Table 1

Introduction Rectal prolapse is a disabling condition which is under-reported and affects the quality of life of our ageing population. Despite this there is ‘no accepted standard procedure’1a given patient should receive. The perceived risk of surgery has meant that elderly patients often undergo a perineal operation with an abdominal operation being reserved for younger patients or those with recurrence. Randomised controlled trials have found it challenging to recruit patients making comparison between outcomes difficult for abdominal and perineal operations. Method The Surrey and South West London Pelvic floor group was founded in 2014 and includes the following hospitals – Ashford and St Peters Hospital, Croydon University Hospital, East Surrey Hospital, Epsom and St Heliers Hospital, Frimley Park Hospital, Kingston Hospital, Royal Berkshire Hospital, St Georges Hospital and Wexham Park Hospital. All patients who underwent surgery for full thickness rectal prolapse between April 2011 and March 2013 were included. Data was collected retrospectively from the notes using a standardised proforma. Results 244 patients underwent surgery for full thickness rectal prolapse in the study period. Seven patients were excluded due to incomplete data leaving 237 patients. All but four patients were female. Median age at time of operation was 78.4 years with an average ASA of 2.1. The recorded overall recurrence for all surgery was 17.7%. Median length of stay (LOS) was 2 days. Conclusion In this retrospective multicentre study abdominal operations for full thickness rectal prolapse had a significantly lower rate of recurrence than the perineal approach. This was despite there being a higher proportion of patients in the abdominal group who had had previous surgery for rectal prolapse. Although patients in the abdominal group were younger and fitter there was no difference in length of stay and complication rates. The rates of recurrence for perineal operations were similar1but the recurrence rate after abdominal operations was higher than previousy reported in the literature.1This may be a reflection of the individual learning curves for laparoscopic rectal prolapse surgery during the study period (2011–2013). Disclosure of interest None Declared. Reference Senapati A, Gray RG, Middleton LJ, et al.; PROSPER Collaborative Group. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68

Comparison of Surgical Treatments for Trigeminal Neuralgia: Reevaluation of Radiofrequency Rhizotomy

Comparison of Surgical Treatments for Trigeminal Neuralgia: Reevaluation of Radiofrequency Rhizotomy

Canine ureteral ectopia: an analysis of 175 cases and comparison of surgical treatments

The case histories of 175 dogs with ureteral ectopia were reviewed; there were 156 females and 19 males. Golden retrievers, labrador retrievers and Skye terriers appeared to be over-represented. Their median age when examined was 10 months, and the males were significantly older than the females. Fifty-six animals were affected bilaterally, 50 were affected on the left side alone and 69 on the right side alone. One hundred and twenty-two cases had other abnormalities and 67 had more than one; they included hydro-ureter, hydronephrosis, pyelonephritis, bladder hypoplasia and congenital incompetence of the urethral sphincter mechanism. Forty-one cases were not treated, and the other 134 were treated by ureteronephrectomy, extravesicular ureteric transplantation or intravesicular ureteric transplantation. One hundred and twelve cases were available for follow-up for a median period of over two years (range one month to 15 years). The response to surgery and the incidence of complications was similar after each method of treatment. Sixty-five of the 112 cases were cured of incontinence and 26 were improved. The complication rate (14 per cent overall) was similar for each procedure although different types of complications occurred. Hydronephrosis occurred most commonly after extravesicular transplantation and dysuria occurred most commonly after intravesicular transplantation.

A cost-effectiveness comparison of surgical treatments for mitral valve disease.

This study compares the cost-effectiveness of mitral valve reconstruction and replacement. Published clinical data were used to determine the effectiveness of each procedure. Both direct and indirect costs were calculated. The findings indicate that reconstruction has lower costs per year of life extended than replacement due to better outcomes. Changing outcome probabilities and discount rates did not alter these results. Cost savings in excess of 40% may be achieved by early reconstruction for suitable patients. These results suggest that the prevailing practice of delaying surgery until replacement is needed should be reconsidered, especially for patients who could benefit from reconstruction.