Conventional Open Approach Research Articles

Comparison of the Efficacy and Safety of Thoracoscopic Surgery and Conventional Open Surgery for Congenital Diaphragmatic Hernia in Neonates: A Meta-analysis.

Thoracoscopic surgery is an increasingly popular surgical technique for the repair of congenital diaphragmatic hernias. We performed a meta-analysis to compare the efficacy, safety of thoracoscopic surgery and the conventional open surgical approach for congenital diaphragmatic hernia in neonates. A systematic search of electronic databases such as PubMed, Google, and Web of Science was performed to identify studies comparing thoracoscopic surgery and open surgery for congenital diaphragmatic hernia. A total of 6 studies with 3348 patients were found. Parameters such as operation time, hospital stay, recurrence rate, postoperative mortality, and postoperative complications were pooled and compared by meta-analysis. Of the 3348 children with congenital diaphragmatic hernia included in the 6 studies, 615 underwent thoracoscopic surgery and 2733 underwent open surgery. All studies were nonrandomized controlled trials. The operation times were shorter for thoracoscopic surgery than for open surgery in three studies, but there was no significant difference (standard mean difference = 1.25, confidence interval [CI] = [-0.48-2.98], P = 0.16). In the thoracoscopic surgery group, the rate of postoperative deaths was significantly lower (95% CI = 1.24-2.75), but the occurrence of recurrences was more frequent (95% CI = 0.08-0.23). The hospital stay varied significantly across studies. There was a statistically significant difference (standard mean difference = -1.47, CI = [-2.24--0.70], P < 0.001) in the overall effect between the groups. The complication rate was significantly lower with thoracoscopic surgery compared to open surgery (odds ratio = 0.26, CI = [0.10-0.66], P = 0.004) for the overall effect between the groups. The thoracoscopic procedure, however, was planned for milder and stable cases. Thoracoscopic repair of congenital diaphragmatic hernia in neonates is associated with a shorter length of hospital stay, fewer complications, and less postoperative mortality than traditional open repair. However, the rate of recurrence was found to be higher in those who underwent thoracoscopic surgery.

Comparison of clinical and radiographic outcomes in unilateral transforaminal lumbar interbody fusion: a retrospective analysis of three surgical approaches.

The primary objective of this study is to evaluate and compare the clinical and radiographic outcomes of the combined spinous process-splitting approach with a Wiltse (SPSW) approach, the combined conventional approach with a Wiltse (CW) approach, and the conventional open (CO) approach in unilateral transforaminal lumbar interbody fusion (TLIF). The clinical outcomes were assessed, and intraoperative data and complications were collected. Numeric Rating Scale (NRS) scores for low back pain and leg pain, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores for evaluating functions of the lumbar spine and health-related quality of life, and the modified MacNab standard for assessing satisfaction were analyzed. Radiographic outcomes included disc space height, segmental lordosis, interbody fusion assessment, and the rate of muscle atrophy of the multifidus and the erector spinae muscles. Among the three groups, the SPSW group exhibited the shortest operation and drain retention time, lowest intraoperative blood loss, and minimal postoperative blood loss. Notably, the SPSW group displayed the highest level of social life function based on the JOABPEQ, and the highest level of patient satisfaction according to the modified MacNab Criteria, along with the lowest rate of muscle atrophy. All the SPSW, CW, and CO approach TLIF procedures achieved overall satisfactory effects of decompression and fusion for lumbar degenerative diseases. The SPSW approach procedure appears to be associated with the smallest surgical trauma and highest satisfaction because of reducing iatrogenic injury of the paraspinal muscles.

Enhanced recovery and reduced conversion rates in robotic rectal cancer surgery: a single-center retrospective cohort study.

This study aimed to compare the outcomes of robotic-assisted rectal resection with conventional laparoscopic and open approaches, focusing on complication rates, conversion rates, length of hospital stay, and oncologic outcomes. A retrospective single-center cohort study included 106 patients with non-metastatic rectal cancer (UICC stages I-III) who underwent rectal resection from January 2013 to December 2023. Patients were assigned to open surgery (n = 23), conventional laparoscopic surgery (n = 55), or robotic-assisted surgery (n = 28). Robotic surgery demonstrated significantly lower conversion rates compared to minimal-invasive surgeries (p = 0.047) and shorter hospital stays (11.5 ± 8days) compared to open (17.91 ± 12days) and laparoscopic (17.2 ± 14days) surgeries (p = 0.001). The quality of the specimen was significantly better (Score 1) in robotic (85.71%) and open (89.09%) cases compared to laparoscopic approaches (47.83%) (p < 0.001). Laparoscopic surgery was identified as a risk factor for worse specimen quality (p < 0.001). Older patients (> 63years) had a higher risk for conversion in univariate analysis (p = 0.049). Morbidity was comparable between the groups (p = 0.131), and the anastomotic leakage rate did not differ significantly (laparoscopic: 18.18%, open: 13.04%, robotic: 17.86%). Kaplan-Meier survival curves showed no significant differences in overall survival probabilities among the groups. Robotic-assisted rectal resection provides significant advantages in terms of lower conversion rates, better specimen quality, and shorter hospital stays while maintaining comparable complication rates and oncologic outcomes to conventional laparoscopic and open approaches. These findings support robotic surgery as a standard treatment option for rectal cancer.

Minimally Invasive Anterolateral Cervical Cordotomy for Intractable Cancer Pain Using Microtubular Retractors: A Single Institution Case Series.

As advancements in cancer treatments have allowed patients with a high burden of disease to live longer, the number of patients who present with debilitating refractory pain has increased. Anterolateral cordotomy has long been used for the treatment of intractable unilateral cancer pain using either an imaging-guided percutaneous approach or an open surgical approach. In this report, we describe a novel minimally invasive modification to the open surgical approach. It combines the benefits of both approaches by providing direct visualization for lesioning without the collateral tissue damage of an open approach. This retrospective study evaluated medical records, operative reports, and imaging studies of patients who underwent a minimally invasive cordotomy at a single institute between 2018 and 2022. The surgical technique involved a microscope-assisted C2 hemilaminectomy using microtubular retractors followed by dural opening and anterolateral cordotomy under direct visualization and with intraoperative neurophysiological monitoring. Eleven patients were included in the study. None were converted to an open approach, and no wound-related postoperative complications were observed. A clinically significant decrease in pain was observed after the procedure, and 10 of the 11 patients (91%) were ambulatory by the time of analysis. Compared with image-guided percutaneous cordotomy, anterolateral cervical cordotomy with microtubular retractors potentially improves the safety of the procedure through direct visualization while being less invasive than a conventional open approach. Our preliminary experience with this technique demonstrates the feasibility of the approach, as it was both safe and effective.

Gasless trans-axillary endoscopic versus conventional open hemithyroidectomy for thyroid cancer patients: A propensity score-matched analysis of quality of life and oncological outcomes: A cross-sectional questionnaire study

BackgroundThyroid cancer predominantly affects young females who seek surgical intervention not only for excellent oncological outcomes but also for a high quality of life (QOL) and favorable cosmetic and functional outcomes. The gasless trans-axillary endoscopic (GTAE) approach is a commonly used remote access technique for thyroid surgeries. It holds the potential for comparable oncological outcomes and superior QOL, cosmetic, and functional outcomes. However, robust evidence supporting this hypothesis is scarce. Materials and MethodsWe collected data from patients diagnosed with papillary thyroid carcinoma who underwent hemithyroidectomy with central compartment dissection at Peking Union Medical College Hospital (PUMCH) between December 2019 and January 2023. After applying propensity-score matching analysis (PSMA), a total of 424 cases were included. For oncological outcomes, patients in both groups were prospectively followed through regular outpatient visits. The QOL, functional, and cosmetic outcomes were assessed using a cross-sectional online questionnaire, including EORTC-THY34 for QOL, PSAQ for cosmetic outcomes, SIS-6 for swallowing functions, and VHI-10 for voicing functions. We further compared oncological outcomes, QOL, functional, and cosmetic outcomes between these two groups. ResultsA total of 274 cases provided validated responses: 141 underwent the GTAE approach, and 134 underwent the conventional open (CO) approach. The operation time was approximately 60 minutes longer in the GTAE group. Notably, there was no difference in complications between the two approaches. Rates of suspicious recurrence in both groups remained low and showed no significant differences (2.55% vs. 1.57%, p>0.05). No pathological confirmed recurrence was reported in either group. Patients with the GTAE approach showed better body image and less joint pain (EORTC-THY34), better swallowing (SIS-6), and better cosmetic outcomes (PSAQ). Voice outcomes showed no difference between these two approaches (VHI-10). ConclusionCompared to the CO approach, hemithyroidectomy with central compartment dissection via the GTAE approach in low-risk patients maintains comparable oncological outcomes while offering better QOL, cosmetic benefits, and functional outcomes.

Outcomes of Adult Right Graft Living Donor Liver Transplantation Utilizing the Robotic Platform-integrated Real-time Indocyanine Green Fluorescence Cholangiography Compared to the Open Approach.

This study aimed to assess short-term biliary outcomes in adult living donor liver transplants using right grafts, comparing robotic surgery with real-time indocyanine green fluorescence cholangiography for optimal hilar plate transection, against the conventional open approach. Determining the optimal transection plane through the hilar plate is crucial in donor hepatectomies, impacting outcomes significantly. From 2011 to 2023, a total of 839 right graft living donor hepatectomies were performed, with 414 (49%) performed via the open approach and 425 (51%) utilizing the robotic platform. The magnetic resonant cholangiopancreatography predictions correlated moderately with the actual count of graft ducts ( r =0.57, P <0.001). Out of all 839 right donor hepatectomies, 321 (44%) were single duct grafts, of which 193/425 (49%) were retrieved with the robotic while 128/414 (38%) were with the open approach (OR: 1.58, 95% CI: 1.16-2.14), P =0.003). Overall, 50 (6%) of the donors developed a biliary complication during their hospital stay, of whom 38 (9%) were grafts retrieved with the open, while 13 (3%) with the robotic approach (OR: 0.31, 95% CI: 0.15-0.61, P <0.001). Similarly, 63 (15%) of the adult recipients developed a biliary complication of any severity when grafts were retrieved with the open approach compared to 35 (8%) with the robotic approach (OR: 0.50, 95% CI: 0.31-0.79), P =0.002). The robotic platform with integrated real-time indocyanine green fluorescence cholangiography during right donor hepatectomy offers improved safety for the donor by accurately addressing the right hilar corridor, resulting in fewer graft ducts and fewer complications for the donor and recipient when compared to the standard open approach.

Evaluating the Efficacy and Safety of Robotic Versus Conventional Completion Thyroidectomy: A 10-year Experience.

Robotic thyroidectomy is gaining popularity, yet its role in completion thyroidectomy remains unclear. We aimed to compare robotic vs conventional completion thyroidectomy for thyroid nodules. This retrospective study analyzed patients undergoing completion thyroidectomy from 2010-2020, either by conventional open technique (n = 87) or a robotic remote-access approach (n = 44). Outcomes were compared between groups. A total of 131 patients were included. The robotic cohort was younger (45.3 ± 14.0 vs 55.5 ± 14.5years, P < 0.001) with a lower BMI (25.9 ± 5.5 vs 33.7 ± 7.8kg/m2, P < 0.001). Operative time was longer for robotic procedures (139min vs 99min, P < 0.001). Hospital stay was shorter after robotic surgery, with 25% discharged the same day as compared to 5.7% in the open thyroidectomy cohort (P = 0.006). Overall rates of complication were comparable (P = 0.65). Transient recurrent laryngeal nerve palsy occurred in 4.6% of patients, which was similar between both cohorts (P = 0.66). Robotic completion thyroidectomy appears safe and effective, achieving shorter hospitalization than conventional open approaches despite longer operative times. Appropriate patient selection and surgical technique optimization are key. Larger prospective studies should investigate costs and long-term patient-reported outcomes.

HYDATID CYST IN CAUDATE LOBE OF LIVER- A THERAPEUTIC CHALLENGE

Background: Treatment of Echinococcal disease depends on the type, size, and location of the cyst, presence of complications, and the experience of the team. Treatment options include percutaneous treatments, surgery, anti-parasitic drugs, and follow-up without intervention. Objectives: To report a case of hydatid cyst located in caudate lobe of liver. Materials and Methods: A 32-year-female, presented with c/o of Pain in abdomen since 1 week localized to right hypochondrium. USG (A+P) was suggestive of hydatid cyst in caudate lobe of liver. MRI was suggestive of hydatid cyst of liver with abutment of left portal vein and IVC. Patient was first started on medical treatment for 6 weeks and then planned for laparoscopic hydatid cyst excision. Cyst was approached laproscopically and fluid aspirated followed by injection of 10% betadine solution (scolicidal) and then reaspirated. Endocyst was removed. The resultant cavity was plugged with omentum. Results: Patient was discharged on POD-3 on T. Albendazole 400 mg BD for 3 months and T. Praziquantal 600 mg once a week for 3 months. After 6 months, patient is symptomatically well and has no complaints or signs of recurrence at present. Conclusion: Minimally invasive laproscopic sugery has more or less replaced the conventional open surgical approach for cystic hydatidosis. Our case is unique due to its location in the caudate lobe of liver alongwith abutment and mild compression of IVC and portal vein which poses a therapeutic challenge to the surgeon. The caudate lobe of the liver is an anatomically complex liver segment. Its unique and intimate location with the hepatic hilum and inferior vena cava (IVC) coupled with its dual supply from both portal pedicles and direct venous drainage into the IVC make vascular control a particular challenge. Technically challenging cyst excision can be performed laparoscopically with its benefits of improved perioperative outcomes.

A controlled study of the hygienic technical evaluation of the transaxillary approach for inflation-free single-port lumpectomy versus conventional transcervical anterior open surgery in radical thyroid cancer resection

ObjectiveTo evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner.MethodsThis work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients’ operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively.ResultsThe length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05).ConclusionCompared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.

Research progress in the anatomy and surgical approach of the parapharyngeal space

The parapharyngeal space, a complex fascial compartment within the head and neck region, encompasses crucial anatomical structures including blood vessels and nerves. Tumors occurring within this space are rare, with the majority being benign in nature. Surgical intervention remains the primary treatment modality; however, managing parapharyngeal space tumors poses significant challenges due to their intricate anatomical configuration. Conventional open surgical approaches have been associated with significant tissue damage and a high prevalence of postoperative complications. Recently, advancements in anatomical studies and surgical techniques have led to significant progress in understanding parapharyngeal space anatomy and improving surgical management. This article aims to provide a comprehensive overview of these developments.

Impact of neoadjuvant chemotherapy on short-term outcomes after simple and complex minimally invasive minor hepatectomy for colorectal liver metastases: A propensity-score matched and coarsened exact matched study

BackgroundIn the last three decades, minimally invasive liver resection has been replacing conventional open approach in liver surgery. More recently, developments in neoadjuvant chemotherapy have led to increased multidisciplinary management of colorectal liver metastases with both medical and surgical treatment modalities. However, the impact of neoadjuvant chemotherapy on the surgical outcomes of minimally invasive liver resections remains poorly understood. MethodsA multicenter, international, database of 4998 minimally invasive minor hepatectomy for colorectal liver metastases was used to compare surgical outcomes in patients who received neoadjuvant chemotherapy with surgery alone. To correct for baseline imbalance, propensity score matching, coarsened exact matching and inverse probability treatment weighting were performed. Results2546 patients met the inclusion criteria. After propensity score matching there were 759 patients in both groups and 383 patients in both groups after coarsened exact matching. Baseline characteristics were equal after both matching strategies. Neoadjuvant chemotherapy was not associated with statistically significant worse surgical outcomes of minimally invasive minor hepatectomy. ConclusionNeoadjuvant chemotherapy had no statistically significant impact on short-term surgical outcomes after simple and complex minimally invasive minor hepatectomy for colorectal liver metastases.

Complications in Vascular and Endovascular Surgery: To Defeat Your Enemy, You Must Know Your Enemy

In recent decades, the field of vascular surgery has been revolutionized by the introduction and ever-rising growth of endovascular techniques for almost all arterial and venous diseases, mainly owing to their reduced morbidity and mortality rates as compared with conventional open surgical approaches [...]

The Mini-Incision Technique Versus Conventional Open Approach for Carpal Tunnel Release: A Retrospective, Comparative Cohort Study.

Background and objective Open carpal tunnel release (OCTR) is the gold standard technique for treating carpal tunnel syndrome (CTS). While mini-incision carpal tunnel release (MCTR) has been introduced as an alternative approach, there have been some concerns over its effectiveness and risks. In light of this, the aim of the study was to compare the long-standing clinical outcomes after MCTR with those following OCTR. Methods We employed a retrospective cohort design for this study. Patients were classified into two surgery groups, followed up for two years, and compared in terms of the following variables: duration of symptoms; pinch strength; grip strength; 2-point discrimination; visual analog scale (VAS) score; Levine symptom score; Levine function score; quick disabilities of the arm, shoulder, and hand (QuickDASH) score; wound pain; and pillar pain. Results The study included data regarding 120 patients, 71.66% of whom were females. The MCTRand OCTRgroups were similar in terms of age, sex, duration of symptoms, and certain other aspects at baseline. The operation duration (15.15 ±2.20 vs. 25.01 ±2.15 minutes, p<0.01) and incision length (11.425 ±1.56vs. 20.35 ±2.43 mm, p<0.01) were significantly shorter in the MCTR group compared to the OCTR group. Wound pain and pillar pain were not documented in the MCTR group at three and six months. The OCTR group had pillar pain in 25% of the patients till two years postoperatively. Conclusion Based on our findings, we propose that MCTR is superior to OCTR. The mini-incision technique has the advantages of small incision and scar, low pain, and faster recovery. Moreover, the technique was also found to be safe with no major complications or recurrence of symptoms. Further randomized control trials may help to re-evaluate the technique andvalidate our findings.

464. MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY IN THE ELDERLY PATIENT: A MULTICENTER RETROSPECTIVE MATCHED-COHORT STUDY

Abstract Background Several studies reported the advantages of minimally invasive esophagectomy over the conventional open approach, particularly in terms of postoperative morbidity and mortality. The literature regarding the elderly population is however scarce and it is still not clear whether elderly patients may benefit from a minimally invasive approach as the general population. We sought to evaluate whether thoracoscopic/laparoscopic (MIE) or fully robotic (RAMIE) Ivor-Lewis esophagectomy significantly reduces postoperative morbidity in the elderly population. Methods We analyzed data of patients who underwent open esophagectomy or MIE/RAMIE at Mainz University Hospital and at Padova University Hospital between 2016 and 2021. Elderly patients were defined as those ≥75 years old. Clinical characteristics and the postoperative outcomes were compared between elderly patients who underwent open esophagectomy or MIE/RAMIE. A 1-to-1 matched comparison was also performed. The difference in overall survival (OS) and disease free survival (DFS) between the two group was also evaluated. Patients &amp;lt;75 years old were evaluated as a control group. Results Among elderly patients MIE/RAMIE were associated with a lower morbidity (39.7% vs. 62.7%, p = 0.005), less pulmonary complications (32.8 vs. 56.9%, p = 0.003) and a shorter hospital stay (13 vs. 18 days, p = 0.03). Comparable findings were obtained after matching. Among &amp;lt;75 years-old patients, a reduced morbidity (31.2% vs. 43.5%, p = 0.01) and less pulmonary complications (22% vs. 36%, p = 0.001) were detected in the MI group. No difference was detected in the OS of the &amp;gt;75y MI group (26 months) and the &amp;gt;75y open group (19 months)(p = 0.84). The DFS was also similar (26 months vs. 13 months, p = 0.25). Conclusion Therefore, minimally invasive esophagectomy improves the postoperative course of elderly patients reducing the overall incidence of postoperative complications, particularly of pulmonary complications.

Traumatic bilateral lumbosacral facet dislocation without fracture: illustrative case.

Traumatic bilateral lumbosacral facet dislocations without fractures are extremely rare. Only 7 cases have been documented since the first description by Watson-Jones in 1974. Although various treatment strategies have been reported, no consensus has been reached regarding the best surgical approach. A 35-year-old female presented for medical attention following a high-speed motor vehicle collision. She sustained multiple injuries, including an abdominal aortic injury requiring emergent thoracic endovascular aortic repair. She was found to have bilateral lumbosacral dislocation without fracture (L5-S1) and was noted to be neurologically intact. Once medically stabilized, the patient was taken to the operating room for minimally invasive reduction and stabilization of her lumbosacral spine. Postoperatively, the patient was neurologically intact and remained stable with no deficits and appropriate lumbosacral alignment throughout her 2-year follow-up. The authors report a minimally invasive approach to the management of bilateral lumbosacral facet dislocation without fracture. Although conventional open approaches have been described previously, consideration should be given to minimally invasive strategies in select patients to facilitate their rehabilitative postoperative course.

Role of Therapeutic Endoscopic Ultrasound in Management of Pancreatic Cancer: An Endoscopic Oncologist Perspective.

Pancreatic cancer is a highly lethal disease with an aggressive clinical course. Patients with pancreatic cancer are usually asymptomatic until significant progression of their disease. Additionally, there are no effective screening guidelines for pancreatic cancer in the general population. This leads to a delay in diagnosis and treatment, resulting in poor clinical outcomes and low survival rates. Endoscopic Ultrasound (EUS) is an indispensable tool for the diagnosis and staging of pancreatic cancer. In the modern era, with exponential advancements in technology and device innovation, EUS is also being increasingly used in a variety of therapeutic interventions. In the context of pancreatic cancer where therapies are limited due to the advanced stage of the disease at diagnosis, EUS-guided interventions offer new and innovative options. Moreover, due to their minimally invasive nature and ability to provide real-time images for tumor localization and therapy, they are associated with fewer complication rates compared to conventional open and laparoscopic approaches. In this article, we detail the most current and important therapeutic applications of EUS for pancreatic cancer, namely EUS-guided Fine Needle Injections, EUS-guided Radiotherapy, and EUS-guided Ablations. Furthermore, we also discuss the feasibility and safety profile of each intervention in patients with pancreatic cancer to provide gastrointestinal medical oncologists, radiation and surgical oncologists, and therapeutic endoscopists with valuable information to facilitate patient discussions and aid in the complex decision-making process.

Usefulness of Percutaneous Pedicle Screw Fixation for Treatment of Lower Lumbar Burst (A3-A4) Fractures: Comparative Study with Thoracolumbar Junction Fractures.

Percutaneous pedicle screw fixation (PPSF) without fusion has been recently recommended in the treatment of thoracolumbar fracture to reduce the adverse effects associated with the conventional open approaches and to restore range of motion. However, those studies report on the thoracolumbar junction, and there is no report on lower lumbar fracture. To assess effectiveness of PPSF without fusion for treating lower lumbar burst (A3 and A4) fractures. A retrospective analysis was made to evaluate consecutive 50 patients with AO type A3 and A4 thoracolumbar fracture underwent PPSF. Patients were divided into a thoracolumbar junction (TLJ) group (T11-L2) and lower lumbar (LL) group (L3-5). The following items were measured and compared between the two groups. Vertebral height and consolidation, retropulsed fragment, sagittal curve and fixation failure were assessed with certain interval regularly. The average height at pre- and post-reduction were 56.2% (36.2-74.3), 95.3% (84.2-98.3) in TLJ group and 65.7% (45.7-86.2), 91% (73.1-100) in LL group. The average canal area occupancy rate at pre- and post-reduction were 46.1% (37.4%-67.5%), 38.1% (31.3%-40.8%) in TLJ group and 40.4% (15.0-65.7), 19.3% (9.4-26.6) in LL group. Consolidation was completed within 12months after surgery in both groups. There was no significant difference between two groups in clinical and radiographic parameters except cobb angle loss. Patients with lower lumbar fracture can be effectively managed with PPSF without fusion. PPSF following the implant removal can restore the movement of the lower lumbar spine, which is essential for daily life.

Minimally invasive Ivor Lewis esophagectomy in the elderly patient: a multicenter retrospective matched-cohort study.

Several studies reported the advantages of minimally invasive esophagectomy over the conventional open approach, particularly in terms of postoperative morbidity and mortality. The literature regarding the elderly population is however scarce and it is still not clear whether elderly patients may benefit from a minimally invasive approach as the general population. We sought to evaluate whether thoracoscopic/ laparoscopic (MIE) or fully robotic (RAMIE) Ivor-Lewis esophagectomy significantly reduces postoperative morbidity in the elderly population. We analyzed data of patients who underwent open esophagectomy or MIE/RAMIE at Mainz University Hospital and at Padova University Hospital between 2016 and 2021. Elderly patients were defined as those ≥ 75 years old. Clinical characteristics and the postoperative outcomes were compared between elderly patients who underwent open esophagectomy or MIE/RAMIE. A 1-to-1 matched comparison was also performed. Patients < 75 years old were evaluated as a control group. Among elderly patients MIE/RAMIE were associated with a lower overall morbidity (39.7% vs. 62.7%, p=0.005), less pulmonary complications (32.8 vs. 56.9%, p=0.003) and a shorter hospital stay (13 vs. 18 days, p=0.03). Comparable findings were obtained after matching. Similarly, among < 75 years-old patients, a reduced morbidity (31.2% vs. 43.5%, p=0.01) and less pulmonary complications (22% vs. 36%, p=0.001) were detected in the minimally invasive group. Minimally invasive esophagectomy improves the postoperative course of elderly patients reducing the overall incidence of postoperative complications, particularly of pulmonary complications.

Median Arcuate Ligament Syndrome: Comparing the Safety of Open and Laparoscopic Management in a Large Cohort

Open surgery has been the traditional approach for Median Arcuate Ligament Syndrome (MALS) management. However, there has been a recent rise in laparoscopic management for MALS. In this study we used a large-scale database to compare perioperative complications between open and laparoscopic approaches for MALS. Using the National Inpatient Sampling database, we identified all patients surgically treated for MALS between 2008 -2018 through conventional open and laparoscopic approaches. ICD 9 and 10 codes were used to identify patients and their specific surgical interventions. Statistical analyses were conducted to compare the perioperative complications between the two MALS surgical approaches, as well as and length of hospital stays and total charges. The complications include postoperative bleeding, accidental operative laceration/puncture, surgical wound infection, ileus, hemothorax/pneumothorax, and cardiac and respiratory complications. A total of 630 patients were identified: 487 (77.3%) patients underwent open surgery while 143 (22.7%) patients underwent laparoscopic decompression. The majority of the study population consisted of female patients (74.8%) with a mean age of 40.6 ± 19 years. Patients who underwent laparoscopic decompression had significantly less all-cause perioperative complications compared to their open surgery counterparts (0.7% vs. 9.9%; P = .001). Additionally, prolonged hospitalization was noted in the open group compared to the laparoscopic one (5.8 days vs. 3.5; P<.001, respectively) with a significantly higher mean of total hospital charges ($70,095.8 vs. 56,113.5; P =.016). Laparoscopic management of MALS has significantly less perioperative complications than open surgical decompression with shorter hospitalization and lower total charges. Given that, laparoscopic technique could be a safe option in treating select MALS patients.

Effect of Impression Technique on Denture Retention and Patient Satisfaction: A Comparative Clinical Study

Objectives: To compare satisfaction levels of patients wearing maxillary completes denture fabricated by closed mouth and an open mouth impression techniques. Methods: This Comparative clinical study was conducted at the Department of Prosthodontics, Armed Forces Institute of Dentistry (AFID), Rawalpindi. Eighty-four edentulous patients were included in this study; the patients were randomly allocated into two groups. Group A patients were provided with dentures fabricated by closed mouth impression technique and Group B patients were provided with dentures fabricated by open mouth impression technique. The patient’s satisfaction level was assessed after six weeks of denture insertion with a questionnaire attached as Annex-A. Results: Out of 42 patients in group A, 12 were highly satisfied, 28 moderately satisfied and 2 poorly satisfied. In group B patients, 9 were highly satisfied, 25 moderately satisfied and 8 poorly satisfied. Retention was highest (81.0%) in patients of group A compared to group B (19%). Moderately satisfied patients were more significantly (p=0.04) more (69.0% in group A and 71.4% in group B) comfortable compared to highly satisfied (26.2% in group A and 19.0% in group B) and poorly satisfied (4.8% in group A and 19.5% in group B) in both groups. There was no statistically significant difference among patients in both groups when their satisfaction with their ability to chew with dentures was compared. Regarding satisfaction with speech ability more patients were moderately satisfied (28.6% in group A) compared to the number of patients (21.4%) in group B. Overall, 70.2% of moderately satisfied category showed significantly higher frequency of patients followed by 17.9% patients each lying in highly satisfied and poorly satisfied patients, categories. Clinical implication: Final impression in complete denture (CD) fabrication is very crucial step that can affect overall prognosis of CD treatment and therefore, patient satisfaction with CDs. A simplified closed mouth impression approach to complete denture treatment, omitting the border molding and definitive impression appointment, has been suggested as an alternative to the conventional open mouth approach. Conclusion: Dentures fabricated by closed mouth impression technique are more stable and functionally better compared to those constructed by open mouth impression technique. Keywords: Final impression technique, complete dentures, Retention, Comfort, Speech ability, Patient Satisfaction