Decrease In Intraoperative Blood Loss Research Articles

The surgical outcomes in management of jugular foramen paragangliomas with tension free anterior rerouting of the facial never and tunnel packing of the inferior petrous sinus

Objective:The aim of this study is to evaluate the safety and efficacy of surgical interventions ofjugular foramen paragangliomas（JFP） utilizing modified surgical techniques, tensionfree anterior rerouting of the facial nerve and tunnel-packing or push-packing of the inferior petrous sinus. Methods:A retrospective analysis was conducted on a cohort of 88 patients diagnosed with JFP and treated at the Eye Ear Nose and Throat Hospital of Fudan University（in Shanghai, China） from October 2010 to June 2021. The surgical outcomes were analyzed for tumor classification, intraoperative conditions, and function of the postoperative facial nerve（FN） and lower cranial nerve（LCN）. Results:The study included a total of 88 patients, gross total resection was achieved in 70 patients（79.5%）, near total resection was obtained in 17 patients（19.3%）, and one patient undergoing subtotal resection. The average of intraoperative blood loss was 448.3 mL. Additionally, 24 patients underwent surgical total anterior rerouting（TAR）, 18 patients underwent surgical total FN tension free anterior rerouting（TF-TAR）, and 18 patients underwent surgical FN partial FN tension free anterior rerouting（TF-PAR）. Good postoperative FN function（House-Brackmann Ⅰ-Ⅱ） was achieved in 62.5% of TAR group. In the TF-TAR and PF_TAR groups, good postoperative FN function was demonstrated in 88.9% patients. It showed a significantly improvement of the FN function following application of tension-free FN anterior rerouting technique（P=0.007）. Twenty patients（22.7%） suffered from at least one LCN deficit in the preoperative evaluation. The postoperative LCN deficits was correlated with the Fisch classification of tumors, which showed a lower incidence of LCN dysfunction in classes C1-C2（4.9%, 2/41cases） and poorer outcomes of LCN dysfunction in classes C3-D（8.5%,4/47cases ）, it was likely less impacted the LCN function in the early stage tumor. Conclusion:The application of modified surgical techniques of FN tension-free anterior rerouting and tunnel-packing of the inferior petrous sinus has been shown to effectively preserve the function of the FN and LCN, decrease intraoperative blood loss, and ultimately improve patients' postoperative quality of life.

Double reverse traction repositor assisted closed reduction and internal fixation versus open reduction and internal fixation for treatment of lateral tibial plateau fractures among the elderly.

In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs. From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications. The DRTR assisted CRIF group experienced a 43.6mL decrease in intraoperative blood loss (161.3ml vs 204.9ml, p = 0.033), and the operation duration was 32.1min shorter than the ORIF group (83.8min vs 115.9min, p < 0.001). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) immediately after surgery and at the last follow-up. No differences in malreduction (p = 0.566) or reduction loss (p = 0.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, p = 0.934; 89.3 ± 7.8 vs 86.9 ± 6.2, p = 0.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, p = 0.008). Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.

Evaluation of the effectiveness of a new surgical correction method for combined pelvic organ prolapse in women of reproductive age: A prospective non-randomized study

Aim. To evaluate the effectiveness of combined pelvic organ prolapse correction using the proposed modification of laparoscopic promontofixation of the uterus and vaginal walls using a mesh graft in women of reproductive age. Materials and methods. A prospective non-randomized study included 41 women of reproductive age (up to 49 years) with grade II–IV symptomatic combined pelvic organ prolapse. The main group (n=19) included women who underwent surgery using the proposed original method (invention patent No. RU2795649C1 dated October 27, 2022), the control group (n=22) included women who underwent conventional laparoscopic promontofixation of the uterus and vaginal walls and vaginal plasty with local tissues. The duration of surgery, intraoperative blood loss, anatomical result, effect on symptoms and sexual function were assessed using the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results. The duration of surgery and intraoperative blood loss were significantly lower in the main group (p=0.043 and p0.001, respectively). Anatomical success was achieved in both groups and persisted throughout the follow-up period (without statistically significant differences). Analysis of the PFDI-20 questionnaire responses showed a significant improvement in both groups with no statistically significant differences. Analysis of the PISQ-12 questionnaire data showed a significant improvement in the quality of sexual life in both groups; however, after a year of follow-up, patients of the main group had a significantly better quality of sexual life (p0.05). Conclusion. The surgical correction of combined pelvic organ prolapse using the proposed method demonstrated a good anatomical result, a decrease in intraoperative blood loss and duration of surgery, as well as an improvement in sexual function in women of reproductive age.

Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L4, 5 degenerative lumbar spondylolisthesis

To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L4, 5 degenerative lumbar spondylolisthesis (DLS). The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). OSE-assisted posterolateral approach lumbar interbody fusion for L4, 5 DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.

3D Printing Technology in Pediatric Orthopedics: a Primer for the Clinician.

This article reviews the basics of 3D printing and provides an overview of current and future applications of this emerging technology in pediatric orthopedic surgery. Both preoperative and intraoperative utilization of 3D printing technology have enhanced clinical care. Potential benefits include more accurate surgical planning, shortening of a surgical learning curve, decrease in intraoperative blood loss, less operative time, and fluoroscopic time. Furthermore, patient-specific instrumentation can be used to improve the safety and accuracy of surgical care. Patient-physician communication can also benefit from 3D printing technology. 3D printing is rapidly advancing in the field of pediatric orthopedic surgery. It has the potential to increase the value of several pediatric orthopedic procedures by enhancing safety and accuracy while saving time. Future efforts in cost reduction strategies, making patient-specific implants including biologic substitutes and scaffolds, will further increase the relevance of 3D technology in the field of pediatric orthopedic surgery.

Clinical Benefits of LigaSure™ for Surgical Amputation Without Tourniquet Use in Patients With Musculoskeletal Tumor.

Amputation is still a viable option for musculoskeletal tumors that are multi-compartmental, adjacent to neurovascular structures, and involving pathological fractures. Complications such as poor surgical margins, local recurrence and infection after limb salvage surgery are also indications for secondary amputation. An effective hemostatic technique is vital for preventing complications of massive blood loss and prolonged operative time. The use of LigaSure™ in the field of musculoskeletal oncology has not been well documented. This retrospective study included 27 patients with musculoskeletal tumor who underwent amputation using either LigaSure™ system (n=12) or traditional hemostatic technique (n=15) from 1999 to 2020. The purpose of this study was to evaluate the effect of LigaSure™ in terms of intra-operative blood loss, blood transfusion rates, and duration of surgery. The use of LigaSure™ resulted in a significant decrease in intraoperative blood loss (p=0.027) and blood transfusion rates (p=0.020). There was no significant difference for the duration of surgery between the two groups (p=0.634). The LigaSure™ system can potentially improve clinical outcomes in patients with musculoskeletal tumor undergoing amputation surgeries. The LigaSure™ system is a safe and effective hemostatic tool for musculoskeletal tumor amputation surgeries.

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

ObjectiveThis study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.MethodsThe medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.ResultsA total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8–10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47–79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.ConclusionsOur results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

Perioperative management of pediatric patients undergoing juvenile angiofibroma resection. A case series and educational review highlighting patient blood management.

Juvenile nasopharyngeal angiofibromas are one of the most enigmatic, bloody tumors encountered by otorhinolarygnologists, head and neck surgeons, neurosurgeons, and anesthesiologists. Juvenile nasopharyngeal angiofibromas are rare, benign, highly vascular tumors with a propensity towards aggressive local invasion. Surgery, open or endoscopic, to remove the growth is the primary treatment of choice for Juvenile nasopharyngeal angiofibromas. Historically, surgical resection was associated with massive, rapid blood loss, traditionally managed by blood product transfusion and deliberate hypotension. Preventative management employing multimodal blood conservation strategies should be an essential standard of perioperative care for patients with Juvenile nasopharyngeal angiofibromas. We describe a contemporary and comprehensive approach in the management of patients with high grade Juvenile nasopharyngeal angiofibromas. This includes surgical strategies such as preemptive external carotid artery embolization, endoscopic surgical approach, and staged operations, as well as anesthetic strategies including antifibrinolytic therapy and acute normovolemic hemodilution. These surgeries, once synonymous with massive transfusion, may potentially be performed without allogeneic blood transfusion, or deliberate hypotension. Using a case series, the authors introduce a contemporary approach to multimodal, multidisciplinary blood conservation strategies for Juvenile nasopharyngeal angiofibromas surgery. Here in the authors report on an updated contemporary perioperative clinical approach to patients with Juvenile nasopharyngeal angiofibromas. From an anesthetic perspective, we describe the successful use of normal hemodynamic goals, restrictive transfusion strategy, antifibrinolytic therapy, autologous normovolemic hemodilution, and early extubation in the care of three adolescent males with highly invasive tumors. We demonstrate that new surgical and anesthetic strategies have yielded a significant decrease in intraoperative blood loss and eliminated the need for transfusion of autologous red blood cells, which enable improved outcomes. The perioperative approach to elective surgery for Juvenile nasopharyngeal angiofibromas management is presented from a multidisciplinary patient blood management perspective.

Possibilities of cryosurgery in the treatment of the abdominal cavity diseases

Aim. To study the immediate results of the use of cryosurgical instruments and ultra-low temperature liquid nitrogen in diseases of abdominal organs.Materials and research methods. The article presents the results of surgical treatment using ultra-low temperature liquid nitrogen (196oC) for 308 patients with diseases of the abdominal organs in the Department of Liver and Pancreas Surgery of the Institute of Gastroenterology of the Republic of Tajikistan from 2016 to 2022.The results and discussion. The authors proposed an algorithm for the use of the ultra-low temperature of liquid nitrogen in the treatment of diseases of the abdominal organs after the development of the latest cryogenic equipment. It turned out that the resulting cryodestruction leads to the death of parasitic elements of alveococcosis, echinococcosis, and liver tuberculosis, as well as to cytolysis of atypical calls in hepatocellular carcinoma. The most important advantage of liver cryosurgery, especially in concomitant chronic viral hepatitis and liver cirrhosis, is a reliable parenchymal haemo-and cholestasis, a decrease in intraoperative blood loss, an increase in the radicality of an operation, and reliable prevention of intraoperative dissemination of malignant and parasitic diseasesConclusion. The accumulated experience of surgeries for various diseases of the abdominal organs using ultra-low temperature liquid nitrogen allows concluding that cryosurgery of the abdominal organs has an undoubted prospect. The positive characteristic of using cryotechnology in the treatment of severe diseases of abdominal organs suggests that it is advisable to introduce the method into clinical practice on a wide scale.

The Direct Anterior Approach versus the Posterolateral Approach on the Outcome of Total Hip Arthroplasty: A Retrospective Clinical Study.

ObjectiveTo compare the clinical results of the direct anterior approach (DAA) and posterolateral approach (PLA) in total hip arthroplasty (THA) patients.MethodsFrom January 2017 to September 2019, 80 patients who received primary THA in our hospital were retrospectively selected based on the propensity score matching (PSM) method. Baseline characteristics of patients who underwent the DAA and PLA were collected. Moreover, the incision length, intraoperative blood loss, operative time, length of stay, and Harris hip score were compared between patients in the two groups. The CK level was used to assess muscle damage between patients in the DAA and PLA groups. The complications of these two approaches were also evaluated at patients' 12‐month follow‐up evaluation.ResultsThere was no significant difference in baseline characteristics between patients in the two groups (p > 0.05). The patients in the DAA group had a shorter incision length (9.2 ± 0.2 vs 14.7 ± 0.5, respectively; p < 0.05) and shorter length of hospital stay (9.5 ± 0.7 vs 12.9 ± 0.8, respectively, p < 0.05) than patients in the PLA group. Moreover, the DAA was associated with a decrease in intraoperative blood loss compared with the PLA (109.1 ± 12.6 vs 305.1 ± 14.1 ml, respectively, p < 0.05). However, the operation time was longer in patients in the DAA group (130.7 ± 1.7) than in patients in the PLA group (112.6 ± 1.3 min, p < 0.05). The CK level of patients in the DAA group was lower than that of patients in the PLA group (p < 0.05). The CK level at 48 h post‐surgery was negatively correlated with the Harris hip scores at 6 months after THA (r = −0.538, p = 0.000). Compared with patients in the PLA group, the muscle strength of patients in the DAA group was significantly higher than that of patients in the DAA group at 4 days (p < 0.05) and 7 days (p < 0.05) after THA. The Harris hip scores of patients in the DAA group and PLA group were 81.0 ± 0.8 vs 70.8 ± 0.7 at 6 weeks, 93.4 ± 0.9 vs 86.4 ± 0.6 at 3 months, and 96.8 ± 1.1 vs 93.4 ± 0.8 at 6 months, respectively, both p < 0.05. There was no significant difference in the incidence of complications between patients in the DAA and PLA groups (p > 0.05).ConclusionDAA was superior to the PLA in improving hip function after THA. Compared with the PLA, the DAA could reduce muscle damage, which is negatively correlated with hip function. Further multi‐institution studies are required with longer follow‐up durations, and larger patient populations are needed to provide more definitive conclusions.

Exenteraţia pelviană – între istorie şi viitor

Introduction. Advanced pelvic neoplasms are often real trials for oncologists, radiation therapists and onco­lo­gi­cal surgeons. The treatment must be individualized for each patient and it sometimes involves extensive exen­te­ra­tive interventions burdened with significant mor­bi­di­ty. Although known for more than 80 years, pelvic exen­te­ra­tions have undergone countless technical changes over time which led to a decrease in mortality and to improved sur­vi­val and quality of life parameters. Materials and me­thod. In this paper, we aim to carry out a review of the in­ter­na­tio­nal publications dedicated to pelvic exen­te­ra­tions, following the changes undergone by the sur­gi­cal tech­nique and their impact on survival, morbidity as­so­cia­ted with the method and on perioperative mortality. Re­sults. The advances in surgical techniques allowed the ex­ten­sion of the resection in three compartments: pos­te­rior (through resection of the sacrum), lateral (through ex­ten­ded muscle resections, iliac vessel resections followed by va­­rious reconstructive techniques, nerve resections) and an­­te­­rior (through pubic or perineal urethra resections). The de­­ve­lop­­ment of urinary-genital reconstruction techniques also contributed to the improvement of the patients’ qua­li­ty of life. Restoring the pelvic floor by using the grea­ter omentum or other materials like breast implants, bio­­de­­gra­­dable meshes, dura mater or bladder peritoneum cau­ses a decrease in the complications associated with the “empty pelvis syndrome”, responsible for the majority of post-pelvectomy morbidity. Finally, minimally invasive and ro­bo­tic techniques cause a decrease in intraoperative blood loss and duration of hospitalization, at the cost of a longer du­ra­tion of the intervention. Con­clu­sions. The pel­vec­to­my, an operation with a long his­to­ry, in continuous re­in­ven­tion and upgrading, still plays an im­por­tant role in the therapy of advanced primary or re­cur­rent pelvic can­cers, being some­times the only the­ra­peu­tic method that can increase sur­vi­val. However, it re­quires a good selection of patients and must be performed in a spe­cia­lized center in or­der to achieve the best results and to avoid complications.

Comparison between Sevoflurane and Isoflurane for Controlled Hypotensive Anaesthesia in Patients undergoing Craniotomy for Supratentorial Intracranial Surgery: A Randomised Single-blinded Study

Introduction: The controlled hypotensive anaesthesia technique is widely used for decades to create a bloodless surgical field and decrease intraoperative blood loss during neurosurgical procedures. Inhalation agents like isoflurane and sevoflurane provide the benefit of being hypnotic and hypotensive agents at clinical concentrations and predictable dose-dependent effects made them popular in neurosurgery. Aim: To compare the effects of sevoflurane and isoflurane for producing controlled hypotensive anaesthesia in surgeries for supratentorial brain tumours. Materials and Methods: Sixty-six patients of either sex in the age group of 20-60 years, with American Society of Anaesthesiologists (ASA) Grade I and II posted for elective craniotomy for supratentorial brain tumour under general anaesthesia were enrolled for this study. Patients were randomly allocated to two aesthetic regimens: Group I received isoflurane 1 Minimum Alveolar Concentration (MAC), and Group S received sevoflurane 1 MAC. The Systolic Blood Pressure (SBP) was lowered to less than 100 mmHg before the skin incision and was maintained throughout the surgery.If the blood pressure was not maintained within the above-mentioned range, then injection propofol bolus dose of 20 mg was given intravenously. The quality of the surgical field, brain relaxation, blood loss, duration of surgery, and postoperative complications were compared. Time taken for onset and recovery of controlled hypotension and the requirement of propofol for maintaining controlled hypotension in both groups were also compared. Results: The group S had better brain relaxation (N=26 vs N=20), less blood loss (241.5±61.62 vs 380.65±203.9 mL), and a shorter duration of surgery (135.45±25.6 vs 171.4±60.5 minutes) than group I. Group S had a few patients who required propofol (5 vs 17) to maintain controlled hypotension. The mean time to achieve the target Mean Arterial Pressure (MAP) and time to recovery was faster in group S (10.55±2.54 minutes) vs 15.35±0.99 minutes in group I and 12.95±3.24 minutes in Group S vs 17.85±2.21 minutes in Group I, respectively; p&lt;0.001). Conclusion: Sevoflurane is a safer and more potent drug than isoflurane to achieve controlled hypotension during surgery for a supratentorial brain tumour.

Recent Advances in the Clinical Value and Potential of Dexmedetomidine.

Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

P119. Does the use of IV tranexamic acid impact postoperative hemoglobin and hematocrit following anterior cervical discectomy and fusion?

<h3>BACKGROUND CONTEXT</h3> Spinal surgery is often complicated by significant blood loss which can lead to increased patient morbidity and mortality. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has shown promise in decreasing blood loss as well as need for postoperative blood transfusion when given during surgery. <h3>PURPOSE</h3> Recent studies have begun to report on the benefits of TXA when given perioperatively during spinal surgery2. Few studies, however, have looked at the effects of TXA in patients undergoing anterior cervical discectomy and fusion (ACDF). In this study we aimed to evaluate the effectiveness of TXA in reducing intraoperative blood loss in a cohort of ACDF patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective, single-surgeon study at academic medical center. <h3>PATIENT SAMPLE</h3> All patients who underwent primary ACDF during this time either with or without the augment of TXA were included. <h3>OUTCOME MEASURES</h3> The mean differences in intraoperative blood loss as well as the change from pre to post-surgical hemoglobin and hematocrit, measured at presurgical testing 1 week prior to surgery and on postop day 1 were analyzed in TXA-treated patients compared to non-TXA-treated patients. Additionally, the number of patients requiring postoperative drain and average drain output on postoperative day #1 were measured. Mean length of stay in between groups was also analyzed. This study was subject to IRB approval. <h3>METHODS</h3> Medical records for all patients who underwent primary ACDF with a single surgeon at a tertiary center over a 3-year period from September 2016-October 2019 were evaluated retrospectively. <h3>RESULTS</h3> A total of 83 patients underwent primary ACDF during the study period. Three additional patients who underwent revision of ACDF were excluded for the purposes of this study. Of the 83 patients who underwent primary ACDF, 14 received TXA perioperatively while 69 did not receive TXA. Preoperative diagnoses included spinal stenosis, disc herniation, and spondylolisthesis. Distribution of diagnoses was equal among study groups. Patient demographics and comorbidities including age, BMI, cardiovascular disease, respiratory disease, diabetes and smoking status were evaluated and there were no significant differences between groups. Patients who received TXA had significantly lower mean operative blood loss than the non-TXA patients (41.1mL vs 77.4mL p<.05). There was, however, no significant difference in postoperative drop in hemoglobin (0.7 vs 1.0, p=.332) or hematocrit (0.0, 1.8, p=.392) between the two groups. A total of 49 patients in the non-TXA group (71%) required drain placement while 6 patients in the TXA group (43%) had a drain placed (p=.062). There was a trend towards decreased drain output on postop day 1 in the TXA group compared to the non-TXA group (32.3mL vs 40.8mL, p=.056), however it was not significant. There was also no significant difference in average length of stay between TXA and non-TXA patients (3.2 vs 3.6 days, p=.564). <h3>CONCLUSIONS</h3> TXA has been reported as a useful perioperative tool to decrease bleeding associated with spinal surgery. We found in our patients who underwent ACDF that intraoperative use of IV TXA led to a significant decrease in intraoperative blood loss, however, there was no difference in the change in pre and postoperative hemoglobin and hematocrit between ACDF patients who received TXA and those who did not. There was also no difference in mean postoperative length-of-stay between the TXA and non-TXA groups. Additionally, while not significant, there was a trend towards TXA patients being less likely to require a drain postoperatively (p=.062) and those requiring a drain having less output in the early postoperative period (p=.056). While use of TXA perioperatively for ACDF was shown in this study to decrease operative blood loss, this change was not reflected in surgical hemoglobin change or overall length of stay. Further analysis of the benefits of TXA on bleeding in ACDF patients is warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Comparison of Anterior Approach and Posterior Circumspinal Decompression in the Treatment of Giant Thoracic Discs.

Retrospective cohort study. The treatment of giant thoracic disc herniation (gTDH)remains challenging for surgeons worldwide because of its large volume and calcified or ossified nature and the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. We aim to compare the anterior decompression and spinal fusion (ASF) and posterior circumspinal decompression and spinal fusion (PCDF) for patients with myelopathy due to gTDH in the largest study to date by sample size. Preoperative and postoperative functional status, surgical details, and complication rates were compared between the 2 groups. A total of 186 patients were included: 63 (33.9%) ASF and 123(66.1%) PCDF. The PCDF group had significantly shorter operation duration (163.06 ± 53.49 min vs. 180.78 ± 52.06 min, P = 0.032) and a significant decrease in intraoperative blood loss(716.83 mL vs. 947.94 mL, P = 0.045), and also a shorter hospital length of stay (LOS) and postoperative LOS (6 vs. 7, P = 0.011). The perioperative complication rate (13.8% vs. 28.6%, P = 0.015) and surgery-associated complication rate(13.0% vs. 27.0%, P = 0.018) were significantly higher in the ASF group. A higher rate of complete decompression was achieved in the PCDF group. There were no observed significant differences in changes in functional status between the 2 groups. PCDF for central or paracentral gTDHs is a highly effective and reliable technique. It can be performed safely with a low complication rate. If either procedure can adequately excise a central or paracentral gTDH, a PCDF approach may be a better option.

Диагностика и хирургическая коррекция истмоцеле после кесарева сечения

Objective. To compare the efficacy of different methods of surgical correction of isthmocele after caesarean section. Patients and methods. The study included 56 patients aged 29–41 years, who were divided into three groups: group 1 (n = 16) – patients who underwent surgical laparoscopy with suturing the uterine wound with single-row separate muscularmuscular sutures; group 2 (n = 23) – patients after repair of the uterus with a double-row continuous seromuscular and muscular-muscular suture performed by laparoscopy; group 3 (n = 17) consisted of patients who underwent laparotomy and suturing the uterine wound with a double-row continuous suture. Results. We developed a three-stage plastic and reconstructive surgical laparotomic and laparoscopic program in case of the uterine scar incompetence, which improved the quality of life in all patients. Pregnancy occurred 9–14 months after plastic and reconstructive surgery on the uterus and resulted in timely surgical delivery in 4 (25%) patients in group 1, in 7 (30.4%) patients in group 2 and in 3 (17.6%) patients in group 3. Two (12.5%) patients in group 1 and three (13.04%) patients in group 2 were observed during pregnancy with a period of 10–28 weeks. Conclusion. The use of laparoscopy ensured better visualization of anatomical structures (vessels, nerves, ureters, bladder), which led to a decrease in intraoperative blood loss, in the risk of damage to adjacent organs and in the development of adhesions, and to accelerated postoperative rehabilitation of patients. Key words: double-row suture, istmocele, laparoscopy, metroplasty

ARTERY-FIRST APPROACH FOR PANCREATODUODENAL RESECTIONS. SAFETY AND ONCOLOGICAL BENEFIT (LITERATURE REVIEW)

The results of treatment of patients with malignant neoplasms of the biliopancreatoduodenal zone remain unsatisfactory. With this localization, pancreatoduodenal resection (PDR) remains the only radical surgical intervention. It is more advisable to start with non-surgical treatment, in the presence of arterial invasion of magistral vessels. This served as an impetus for the development of approaches to determine the presence of tumor invasion in the superior mesenteric artery at the early stage of the operation. The surgical goal of PDR remains to minimize contact with the tumor prior to mobilization and ligation of the supply vessels, as well as to increase the edge of the resection around the superior mesenteric artery. To achieve this goal, a number of researchers have proposed various approaches to the superior mesenteric artery during pancreatoduodenal resection, combined “artery-first approach”.An analysis of the existing artery-first techniques for pancreatoduodenal resections, as well as their effect on the treatment results of patients with periampullary malignant neoplasms, is carried out. When conducting literary searches, the databases Pubmed, Сochrane, EMBASE were used using the MESH keywords “Pancreaticoduodenectomy” in combination with the phrase “artery first”. During this search, 157 articles were found. After further analysis, 53 scientific papers were included in the literature review.Modern studies show a decrease in intraoperative blood loss, a decrease in the frequency of postoperative pancreatic fistulas and gastrostasis, as well as an increase in the frequency of R0 resection when this approach is followed. An unambiguous conclusion about the effectiveness of the artery first accesses when performing pancreatoduodenal resection requires further well-planned randomized clinical trials with a large number of patients.

Meta-analysis of modified Stoppa approach and ilioinguinal approach in anterior pelvic ring and acetabular fractures.

Background:The purpose of this meta-analysis was to compare the efficacy of the modified Stoppa approach (MSA) and ilioinguinal approach (IA) in the treatment of anterior pelvic ring and acetabular fractures.Methods:A literature search was conducted using PubMed, Embase, and Cochrane database for articles that compared MSA and IA in the treatment of anterior pelvic ring and acetabular fractures. All the included articles were evaluated by 2 trained reviewers in accordance with the Cochrane Collaboration Handbook for potential risk. The Jadad decision algorithm and Downs and Black scores were also used to assess the quality of the included studies. The extracted data included operative time, intraoperative blood loss, reduction quality, clinical outcome, and complications.Results:Five articles were included in this meta-analysis, with 186 patients in the MSA group and 219 patients in the IA group. Compared with IA, MSA significantly shortened the operative time (P = .0002), decreased intraoperative blood loss (P = .002), and provided better reduction quality (P = .03). Meanwhile, this meta-analysis suggests no significant difference between MSA and IA regarding clinical outcomes (P = .63) and complications (P = .34). The subgroup analysis of complications also showed no statistically significant difference between the 2 groups (including infection, and vascular and nerve injuries).Conclusion:According to this meta-analysis, the currently available evidence suggests that MSA can significantly shorten operative time, decrease intraoperative blood loss, and provide better reduction quality than IA in the treatment of anterior pelvic ring and acetabular fractures. In addition, in terms of clinical outcomes and complications, no significant differences were found between the 2 groups.Level of Evidence: Level IV, meta-analysis.

Sutureless vaginal hysterectomy

Introduction The ERBE BiClamp appears to be a secure and efficient technique of vaginal hysterectomy (VH). In this study, it provided proficient operative times, and minimum loss of blood and morbidity during the procedure with satisfactory outcomes. Its utilization plays a part in the enhancement of minimally invasive gynecology and it should be promoted. Objective The aim was to evaluate the applicability of VH without suture ligation. Materials and methods A retrospective cohort study was carried out during the period between September 2017 and May 2019 in the Obstetrics and Gynecology Department, Al-Azhar University Hospital, New Damietta. A total of 62 patients posted for VH for benign conditions were enrolled after informed consent. The patients were divided into two groups: the first included 32 cases for the BVS (BiClamp) and the second control group included 30 cases with conventional suture ligation. Results The use of an electrosurgical bipolar vessel sealer resulted in shorter operative time. The median procedure time in the electrosurgical bipolar vessel sealer group was 27.75 vs 43.5 min for the suture group (P=0.005). The median value of estimated blood loss was also statistically less with electrosurgical bipolar vessel sealer [85.8 ml vs 105.4 ml for the suture arm (P=0.043)]. The incidence of complications did not differ statistically between the two groups (P>0.05). Conclusion Bipolar vessel sealer has shown a major decrease in intraoperative blood loss, procedure time, and hospital length of stay. Although complications and postoperative pain did not differ between the two groups, the sealer cases reported less visual analog scale scores compared with the other group.

Pregabalin effects on hypotensive anesthesia during spine surgery

Background Elective lumbar spine surgeries are commonly performed under controlled hypotensive general anesthesia to ameliorate intraoperative blood loss and improve the surgical field. Purpose To demonstrate the effect of preoperative 150 mg oral pregabalin on facilitation of induced hypotension during spine surgery evaluated by the total intraoperative consumption of nitroglycerin required to maintain the targeted mean arterial blood pressure. Patients and methods This prospective, randomized, controlled, double-blinded study included two groups of adult patients, who had undergone elective spinal surgery: the pregabalin group (n=53): received oral pregabalin capsule 150 mg 1 h before general anesthesia and the control group (n=53): received oral placebo capsule. The intraoperative invasive mean arterial blood pressure was maintained at the targeted range of 55–65 mmHg by nitroglycerin infusion titration. The intraoperative hemodynamics, blood loss and postoperative sedation, pain scores, and morphine consumption were recorded. Results There was a statistically significant decrease in the consumption of both intraoperative nitroglycerin and postoperative morphine in the pregabalin group compared with the control group, but there was no concomitant decrease in intraoperative blood loss. Also, there was a statistically significant suppression of stress response to intubation in the pregabalin group. Conclusion Premedication with oral 150 mg pregabalin before elective spinal surgery facilitated induced hypotension. Furthermore, it attenuated the stress response to tracheal intubation and enhanced postoperative analgesia.