Differences In Terms Of Complications Research Articles

Clinical features and outcomes of orthopaedic injuries after the kahramanmaraş earthquake: a retrospective study from a hospital located in the affected region

BackgroundThe purpose of this retrospective, single-institutional study was to report the clinical features and outcomes of orthopaedic injuries after the Kahramanmaraş earthquake.MethodsAn institutional database review was conducted to evaluate the results of patients who applied to our hospital’s emergency department after the Kahramanmaraş earthquake. Trauma patients referred to orthopaedics and traumatology were identified. Patient records were checked for injury type, fracture site, treatment type (conservative or surgical), surgical technique, and outcome. Diagnosis with crush syndrome and the need for haemodialysis were also noted. Bedside fasciotomy was undertaken based on the urgency of the patient’s condition, number of patients and the availability of the operating theatre. A team consisting of a trauma surgeon, a plastic surgeon, a board-certified physician in infectious disease, a reanimation specialist, a general surgeon and a nephrologist followed up with the patients.ResultsWithin the first 7 days following the earthquake, 265 patients were admitted to the emergency department, and 112 (42.2%) of them were referred to orthopaedics and traumatology. There were 32 (28.5%) patients diagnosed with acute compartment syndrome. Fasciotomy was performed on 43 extremities of 32 patients. Of these extremities, 5 (11.6%) were upper and 38 (88.4%) were lower extremities.The surgeries of 16 (50%) of the patients who underwent fasciotomy were performed in the emergency department. There was no significant difference in terms of complications and outcomes between performing the fasciotomy at the bedside or in the operating theatre (p = 0.456).ConclusionsFasciotomy appears to be a crucial surgical procedure for the care of earthquake causalities. Fasciotomy can be safely performed as a bedside procedure based on the urgency of the patient’s condition as well as the availability of the operating theatre.

Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 7 0 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Calcified coronary left main disease treated with and without intravascular lithotripsy: a real word first description

Abstract Background Intravascular lithotripsy (IVL) is a promising balloon-based technique to treat calcified coronary lesions. The evidence of its use in LM disease is scarce and there are no studies reporting a comparison between IVL and conventional techniques for calcified lesions, especially in LM PCI that represented an exclusion criteria of the DISRUPT-CAD trials. Methods The aim of this study is to evaluate safety and efficacy of IVL to treat moderate-severe calcified LM disease from January 2018 to December 2022. We stratified our cohort into two groups 1) patients who underwent LM PCI with IVL treatment (bail-out or upfront) and 2) LM PCI with conventional techniques excluding IVL (cutting balloons, NC/OPN balloons, rotational atherectomy). Efficacy endpoint: device success and stent expansion evaluated either by intravascular imaging or angiographic criteria. Safety endpoint: peri-procedural complications (coronary dissection, perforation, no-slow flow, peri-procedural MI, pericardial effusion) and in hospital death or target vessel failure. Results 87 patients were enrolled, 43 (49.4%) underwent LM PCI with IVL (group A), while 44 (50.6%) were treated with conventional techniques (35 NC balloons, 7 RA, 2 cutting balloons). Intravascular imaging was performed in 69% of cases, the 2 groups were similar in terms of age (77.4±9.63, p=0.94), comorbidity, clinical presentation and angiographic characteristics. Both groups presented severe calcifications in terms of calcium length (11.9±10.3, p=0.87), arc (270° 144-350, p = 0.76, and thickness (1.3 ±0.7 p =0.99) assessed by intravascular imaging. IVUS calcium score was similar between 2 groups (1.53±0.7, p = 0.7). Target vessel was distal LM-proximal LAD in 56.6%. IVL most used balloon was 3.5mm (55%), followed by 4.00mm (38.2%). Impella CP was implanted to support 4 PCI and removed at the end of the procedure. Provisional stenting was performed in 55.1% of cases, while two-stents technique was used in 26.4% (mainly represented by DK-crush). Good stent expansion (&amp;gt;80%) was achieved in 85% of cases, with a certain prevalence for patients treated with IVL. Optimal stent expansion (&amp;gt;90%) was higher in patients treated with IVL (9 in group A vs 3 in group B), although it did not reach a statistically significative difference (p=0.06). No differences in terms of complications and peri-procedural myocardial infarction occurred between the two groups. Conclusions This is the first description of a comparison between IVL and conventional techniques in LM calcified PCI. IVL appeared to be safe and effective with good stent expansion and low rate of peri-procedural complications and in-hospital MACE. LM lesions treated with IVL appeared to reach greater stent expansion compared to other techniques, although it was not statistically significative. Certainly, further trials are warranted to establish longer term outcomes and the benefit of IVL over existing calcium-modification therapies.

Stapled side-to-side anastomosis for ileostomy reversal: a simple and reproducible technique with video.

Protective diverting ileostomy is commonly performed in rectal surgery to avoid septic complications of low colorectal anastomosis. Ileostomy closure usually occurs three months after the surgery and can be realized in two ways: hand sewn or stapled. Existing randomized studies comparing the two techniques showed no difference in terms of complications. Our study describes the standard technique of ileostomy reversal as done in Bordeaux University Hospital in 10 steps individually illustrated and with an explicative video. We also collected data concerning the 50 last patients who underwent an ileostomy reversal in our center from June 2021 to June 2022. Mean duration of the ileostomy closure was 46.8 minutes, and the mean total hospital stay was 4.66 days. Five of 50 (10%) patients had a post-operative bowel obstruction, 2/50 (4%) patients had a post-operative bleeding, 1/50 (2%) patient had a wound infection, and there was no anastomotic leakage observed. Stapled side-to-side anastomosis is a rapid, simple, and reproducible technique for ileostomy reversal. There are no more complications compared to hand-sewn anastomosis. It engenders an additional cost compensated by the gain in operating time which altogether saves money.

Comparaison des différentes ancres dans les réinsertions transosseuses de tendons fléchisseurs profonds en zone I

Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use. This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score. The average age was 38.6 years (±16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH. Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Inotropic support after Acute Coronary Syndrome. Levosimendan or dobutamine? Experience in our center

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Inotropic support after Acute Coronary Syndrome (ACS) is commonly used in Cardiac Critical Care Units (CCU). In this context, dobutamine is widely used, given the large experience with this drug, however recently levosimendan has emerged as a safe and effective alternative. Objective Our objective is to analyze the clinical and prognostic differences between patients treated with dobutamine or levosimendan. We wanted to detect the pattern of use of these drugs and determine the best therapeutic option in our patients. Methods Retrospective observational study of patients admitted for ACS at our CCU between August 2011 and September 2022. Patients treated with dobutamine or levosimendan were included, excluding those who required both drugs. We compared baseline characteristics and clinical events in both therapy groups. Results Our sample included 184 patients admitted for ACS who needed inotropic support during the admission period, with either dobutamine or levosimendan. In our cohort, the mean age was 67.95 +/- 12.04 years. 126 (68.48%) patients received dobutamine and 58 (31.52%) levosimendan. Regarding baseline characteristics of our population, we only found statistically significant differences in Diabetes Mellitus as a Risk Factor (p=0.0172) and Congestive Heart Failure (p=0.0128). We tended to use dobutamine over levosimendan as an inotropic agent in shocked patients (p=0.036). No significant differences were found in other data collected in the clinical history, including noradrenaline or intra aortic balloon pump use, arrhythmic events or in-hospital mortality. Multivariate analysis adjusted for clinical and epidemiological factors detected cardiogenic shock as the only independient predictor of in-hospital mortality. Conclusions In our experience, comparing with levosimendan, dobutamine was the preferred inotropic support in shocked patients. We detected no differences in terms of complications and prognosis between both drugs use.

Clinical Efficacy of Adjuvant Radiotherapy for World Health Organization Grade II Intracranial Meningioma

Maximal surgical resection remains the treatment of choice for grade II meningiomas, and for some authors it is sufficient to guarantee a long indolent course even without postsurgical radiotherapy (RT), but there is no consensus on the use of RT in this patient population. We retrospectively compared clinical and radiologic outcomes between World Health Organization grade I (group A) and grade II (group B) surgically treated meningiomas, focusing on the role of adjuvant RT. We registered clinical, surgical, and radiologic data to detect differences in survival and functional outcome between the 2 groups. The final cohort consisted of 284 patients for group A and 94 patients for group B. Group B showed a higher risk of developing recurrence independently of the extent of resection (7.75% for Group A vs. 27.7% for Group B, P= 0.01). Patients who did not undergo adjuvant RT documented recurrence in 50% of cases, compared with 19% of patients who underwent RT (P= 0.024). There is a weak difference in the risk of developing postoperative seizures in the group submitted to radiotherapy (P= 0.08). Performance status remained stable for both groups, but for Group B it tended to decrease significantly after 1 year with regard to extent of resection and RT. Recurrence is more frequent for grade II meningiomas, even though there are no significant differences in terms of complications and functional outcome. Radiotherapy in grade II meningiomas does indeed lead to better control of recurrence but leads to an increased risk of seizures and reduced performance status.

Trocar vs. Seldinger small bore pleural drains: does the technique influence the outcomes? A prospective single-centre study.

The aim of this study is to compare two positioning techniques of 12-French (Fr) thoracic drains in terms of efficacy, safety, and patient comfort. This is a prospective, non-randomized, competitive, non-inferiority study comparing the Seldinger vs. Trocar technique. The primary endpoint was an analysis of the factors that led to unsuccessful drainage positioning. Between the two groups, clinical variables, procedure times, pain, and complications were compared. Seventy-two patients were enrolled in group 1 (Seldinger) and 45 in group 2 (Trocar). The mean procedural time was 7.93±3.02 min vs. 7.09±3.67 min, respectively (p: 0.33). The mean VAS for procedural pain was 2.22±1.47 vs. 2.80±1.88, p: 0.07, and the mean at day 2 was 3.6±1.2 in the SBWGD group vs. 2.7±1.1 in the Unico Group (p: 0.04). There was no difference in terms of complications, residual effusion, and pneumothorax at the first post-procedural chest X-ray. Four days after the procedure, the drain removal rate was 11.6% in group 1 vs. 25% in group 2 p: 0.063). The chest tube was removed after a mean period of 8.87±7.20 days after resolution of pleural effusion or tube dislodgement (7 cases in group 1 vs. 11 in group 2, p: 0.053). The two techniques resulted in comparable pain and complication rates. Both drains are well-tolerated and efficient at draining pleural effusion, with very low rates of complications and failure. We recommend inserting a longer tube for patients who require chest drainage for an extended period of time.

Composite graft repair in distal finger injuries: emergency room or operating room?

Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms. Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level. Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction. Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.

Low postoperative complication rate with high survival rate and good clinical outcome 9 years after autologous chondrocyte transplantation of the knee joint

PurposeTo investigate postoperative complications and associated risk factors for failure following autologous chondrocyte transplantation (“ACT”) as well as its long-term survival and clinical function. It was hypothesized that ACT is a safe technique for cartilage repair with a low incidence of postoperative complications and rare rates of revision surgery combined with a high long-term survival and good to excellent clinical outcome in long-term-follow-up.MethodsAll patients undergoing ACT-Cs of the knee joint between 2006 and 2012 at the author’s institution were included in this retrospective study. Concomitant procedures had been performed if necessary. Early postoperative complications, revision surgeries, failure and risk factors for those events were evaluated 6 months after the surgery. Long-term clinical outcome was assessed using the Lysholm Score, the Tegner Score, a 10-grade scale for satisfaction and the Visual Analogue Scale (VAS) at a minimum follow-up of 9 years postoperatively. Long-term survival was calculated using revision surgeries, clinical failures and conversion procedures to create a Kaplan–Meier analysis. A subgroup analysis for different defect locations was performed. 139 patients were included in this study (27% female/ 73%male; age 26.7 [21.7; 35.2] years). The median defect size was 4.0 [3.0; 6.0] cm2 (40% medial femoral condyle (MFC), 17% lateral femoral condyle (LFC), 36% patella, 19% trochlea). 97 (70%) of the patients had undergone previous surgery and 84 (60%) underwent concomitant procedures.ResultsPostoperatively, 8% of patients had complications (4% bleeding, 2% arthrofibrosis, 2% infection), 7% of patients needed revision surgery. 12% of patients had a prolonged deficit in ROM, that did not require revision surgery. No significant difference in terms of complications was found between the patellofemoral and femorotibial group. Patients demonstrated good patient reported long-term outcomes 9–15 years after the index surgery (Tegner: 4.7 ± 1.8; VAS: 2.4 ± 2.1; Lysholm: 80 ± 14; satisfaction with operation: 7.3 ± 1.9). Survival rates were 88% at 9 years, 85% at 11 years, and 85% at 13 years after the index procedure. Reasons for failure included debridement of ACT (n = 4; 5%), revision ACT (n = 3, 3%), conversion to total knee arthroplasty (n = 3, 3%) and conversion to High tibial osteotomy (HTO) (n = 1; 1%)).ConclusionThe present study indicates ACT as an effective treatment option for femorotibial- as well as patellofemoral cartilage defects with a high long-term survival and low conversion rate as well as good long-term results regarding knee function and satisfaction. Postoperative complications needing revision surgery are rare. Prolongated deficits of range of motion appear frequently up to six months especially in patellofemoral defects, but can often be successfully addressed by intensified physiotherapy without requiring an arthrolysis.Level of evidenceLevel III.

Catheter-related complications in onco-hematologic children: A retrospective clinical study on 227 central venous access devices.

The use of central venous access devices (CVADs) is of paramount importance to safely deliver antiblastic and support therapies in children with cancer. Though, in pediatric patients, as much as in adults, CVADs are potentially associated with severe complications which may result in unscheduled interruption of therapy, hospitalization, increased morbidity/mortality, and increased cost of care. We have reviewed retrospectively our experience with CVADs in children with solid tumors and hematologic diseases, with the purpose of verifying if the adoption of well-defined insertion and maintenance bundles might be effective in reducing catheter-related complications, and in particular catheter-related thrombosis. A total of 227 CVADs were analyzed: 175 peripherally inserted central catheters (PICCs), 50 centrally inserted central catheters (CICCs), and 2 femorally inserted central catheters. All CVADs were non-valved, non-cuffed power injectable polyurethane catheters; 81% were tunneled. Median dwelling time of CVADs was 172 days, for a total number of 39,044 catheter days. A very low incidence of both symptomatic catheter-related thrombosis (0.9%) and catheter-related blood stream infection (0.56 episodes per 1000 catheter days) was found. Unscheduled removal or guidewire replacement because of mechanic complications occurred in 15.7% of CVADs. There was no difference in terms of complications between PICCs and CICCs or between tunneled and non-tunneled catheters. Our experience with CVADs in oncologic and hematologic children suggests that catheter-related complications may be minimized by the adoption of appropriate insertion and maintenance bundles.

What is the best approach for pediatric kidney stones of moderate-sized between shock wave lithotripsy, ultramini percutaneous nephrolithotomy and retrograde intrarenal surgery?

This study aimed to compare the results of ultramini percutaneous nephrolithotomy (UMP), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with kidney stones 10-20mm size. The files of 159 pediatric patients (36 RIRS, 39 SWL, 84 UMP) with kidney stones were reviewed retrospectively. Preoperative age, sex, stone size and location were evaluated. The three methods were compared in terms of operation and fluoroscopy duration, complications with the modified Clavien grading system, and stone-free rate (SFR) in the postoperative first month. The stone burdens of the groups were similar (P = 0.102). At the end of the first month, SFR was higher in the RIRS and UMP groups compared to the SWL group (88.9%, 92.9% and 69.2%, respectively, P = 0.002). UMP had higher SFR for lower pole stones than the other two methods (P = 0.042). There was no difference in complications between the three methods (P = 0.758). SFR was similar for all three methods in all localizations, apart from lower pole stones. UMP had higher SFR for lower pole stones than the other two methods. There was no difference in terms of complications between the three methods.

Prepectoral breast reconstruction with complete anterior implant coverage using a single, large, square-shaped acellular dermal matrix

BackgroundSeveral studies have discussed various methods of prepectoral direct-to-implant (DTI) breast reconstruction using an acellular dermal matrix (ADM) prosthesis to achieve full coverage. However, methods for anterior coverage have rarely been reported. In this study, prepectoral DTI breast reconstruction with complete anterior implant coverage was performed using a square piece of ADM. This study aimed to introduce our prepectoral DTI technique and determine its functional and cosmetic outcomes as well as compare them with those of existing subpectoral DTI techniques.MethodsThis prospective comparative study focused on 29 patients (35 breasts) and 34 patients (35 breasts) who underwent breast reconstruction via subpectoral implant insertion (control group) and anterior coverage prepectoral implant insertion (anterior coverage group), respectively. Postoperative complications were noted, and breast symmetry was evaluated using the Vectra H2 three-dimensional scanner. The modified Kyungpook National University Hospital Breast-Q (KNUH Breast-Q) scale was used to assess the patient’s subjective satisfaction with the reconstruction and postoperative quality of life.ResultsNo remarkable differences in terms of complications (seroma, skin necrosis, nipple–areola complex necrosis, hematoma, capsular contracture, and infection) were noted in both groups. Compared with controls, considerably better results were observed among those in the anterior coverage group in terms of the mean drain removal period. Furthermore, those in the anterior coverage group showed greater symmetry on three-dimensional scans than the controls; however, this was not statistically significant. Subjective satisfaction and postoperative quality of life measured using the KNUH Breast-Q scale were not significantly different between both groups.ConclusionsConsidering its stability, faster recovery time, and cosmetic benefit, prepectoral breast reconstruction with anterior implant coverage using a single, large ADM is a good choice to perform breast reconstruction with implant insertion in patients who have undergone mastectomy.Level of evidence: II.

CT-guided lung biopsy: diagnostic accuracy and complication rates of biopsy techniques

Objective: We aimed to evaluate the diagnostic accuracy and complication rates of computed tomography (CT)-guided core needle biopsy and fine needle aspiration biopsy (FNAB). Materials and Methods: Patients who underwent CT-guided lung mass biopsy were included. The patients were evaluated in terms of age, gender, lesion diameter, lesion localization, depth of the mass, type of biopsy procedure (core needle biopsies and FNAB). Results: The accuracy rate of FNAB in diagnostic material was found to be 100% in terms of benign, malignant and all lesions. The specificity and sensitivity of FNAB was found to be 100%. The diagnostic accuracy rate of core needle biopsy was found to be 70% in benign lesions, 100% in malignant lesions. The specificity of core needle biopsy was 90% and sensitivity 100%. There was no statistically significant difference between the two biopsy techniques in terms of complications. Conclusion: In conclusion, we found that the diagnostic rates of FNAB and core needle biopsy were close in malignant lesions, the diagnostic rate of core needle biopsy was higher in benign lesions, and there was no difference in terms of complications in both biopsy techniques.

MO122: Bleeding Complications after Allograft Kidney Biopsy and Role of Antiplatelet Therapy

Abstract BACKGROUND AND AIMS Percutaneous biopsy is an important tool for monitoring renal allograft and early diagnosis when dysfunction occurs. Bleeding is the most dangerous adverse event, even if it is rare (risk of 0.5%). Cardiovascular (CV) disease affects 2/3 of elderly with CKD and antiplatelet therapy is taken for primary and secondary prevention of CV events. A systematic review on aspirin discontinuation among 50 279 patients at risk for coronary disease shows a 3-fold risk of adverse CV event. The aim of this study is to compare bleeding complications of antiplatelet administration within 5 days from renal biopsy versus absence of therapy. METHOD We conducted a 10-year (2010–2020) single-centre retrospective study on 285 consecutive ultrasound assisted percutaneous allograft kidney biopsy. We collected information about demographic, laboratory (eGFR, platelets, haemoglobin pre/post biopsy, proteinuria) data, biopsy indication (elective/urgent), clinical presentation [acute kidney injury (AKI)/nephrotic syndrome], needle gauge, use of antiplatelet or anticoagulant, diagnosis and complications (categorized as minor and major, according to the need for intervention). We divided patients in two groups: antiplatelet therapy within 5 days versus therapy discontinuation or absence. Bivariate logistic regression was used to analyse possible risk factors associated with complications. RESULTS Among the 285 patients: 173 patients received antiplatelet agents (low-dose aspirin in &amp;gt;90% of cases) within 5 days from biopsy and 112 patients were not on antiplatelet therapy. Diastolic hypertension, AKI and proteinuria were statistically greater in the group without antiplatelet therapy. Histologic diagnoses were evenly present in the two groups, and no differences were observed in the rate of complications. Major complications were diagnosed in 0/112 patients without antiplatelet therapy and 1/173 patients with therapy within 5 days. Minor complications were documented in 14/112 and in 15/173 patients, respectively. There were no statistically significant differences in terms of complications between antiplatelet therapy within 5 days and absence of therapy (Table 1). Furthermore, there were no differences between taking antiplatelet within 48 h or stopping it within 48 h of the procedure (Table 2). No deaths were attributed to procedure and all events occurred within 24 h from biopsy, irrespective of their severity. The univariate logistic regression model (dependent variable: major complication) documented a lower BMI as a significant risk factor; indeed, this was not confirmed at multivariate regression. The analysis did not find a significant difference between 16-G and 18-G biopsy needle in terms of major/minor complications; however, the use of the latter was associated with a significant lower number of glomeruli in the sample. CONCLUSION Our study suggests that the use of antiplatelet agents within 5 days from procedure does not increase the bleeding risk, so it should be safe to continue the therapy in patients at risk for CV events. However, this is a weak evidence that needs prospective studies to be validated. Our data also suggest that 16-G biopsy needle may be safely used to obtain enough tissue for histologic diagnosis.

Body Mass Index impact on Extended Total Extraperitoneal Ventral Hernia Repair: a comparative study.

Obesity is a risk factor for developing abdominal wall hernias and is associated with major postoperative complications, such as surgical site infection, delayed wound healing and recurrent hernia. Therefore, treating incisional hernia in this patient subgroup is a challenge. We conducted a comparative, prospective study on patients who underwent primary ventral hernia surgery or incisional hernia surgery through the extended totally extraperitoneal pathway, with body mass indices (BMIs) ≤ 30 (no obesity) and BMI > 30 (with obesity). We collected demographic data, preoperative and intraoperative variables, complication and recurrence rate, hospital stay and follow-up as postoperative data. From May 2018 to December 2020, 74 patients underwent this surgery, 38 patients without obesity and 36 with obesity. The median area of the hernia defect measured by CT was 57 cm2 and 93 cm2 in patients without and with obesity, respectively (p = 0.012). The median follow-up was 16months. One patient without obesity experienced some postoperative complication compared with four patients with obesity (p > 0.05). No patient without obesity had recurrent hernia compared with two patients with obesity (p > 0.05). There were statistically significant differences between patients with and without obesity in the size of the hernia defect. However, there were no significant differences in terms of complications, hospital stay, postoperative pain or relapses. Therefore, the minimally invasive completely extraperitoneal approach for patients with obesity appears to be a safe procedure despite our study limitations. Studies with longer follow-ups and a greater number of patients are needed.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Combined with Surgery: A 12-Year Meta-Analysis of this Promising Treatment Strategy for Advanced Gastric Cancer at Different Stages.

This meta-analysis was designed to systematically assess the effectiveness and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) combined with surgery for different stages of advanced gastric cancer (AGC) during the last 12 years. The Cochrane Library, PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) were searched online, and papers were retrieved from other sources. Next, randomized controlled trials (RCTs) and high-quality nonrandomized controlled trials (NRCTs) were selected for this analysis. The meta-analysis was conducted with RevMan5.4 software. The 10 RCTs and 13 NRCTs selected for the study included 1892 patients. The overall survival rates were higher in the HIPEC group at 1 year (risk ratio [RR], 0.52; P = 0.004) and 3 years (RR, 0.63; P < 0.00001) than in the control group for the patients without peritoneal cancer, and the HIPEC group had a significant reduction in the recurrence rate (RR, 0.60; p < 0.00001). Among the patients with peritoneal carcinomatosis (PC), the HIPEC group had significantly higher overall survival rates at 1 year (RR, 0.62; P = 0.00001), 2 years (RR, 0.85; P = 0.002), and 3 years (RR, 0.87; P = 0.0001), with an increase in the overall median survival time of 4.67 months. The two groups showed no statistically significant difference in terms of complications for patients with PC (RR, 1.03; P = 0.93) or without PC (RR, 1.15; P = 0.51). For local AGC without PC, standard surgery combined with prophylactic HIPEC could prolong survival and reduce the recurrence rate without more complications. The prognosis of this treatment strategy for patients with PC is closely related to patient selection. Complete cytoreduction combined with therapeutic HIPEC could prolong survival.

Enhanced Recovery After Surgery protocol for elderly gastric cancer patients: A prospective study for safety and efficacy

BackgroundEnhanced Recovery After Surgery (ERAS) has been used to improve surgical outcomes in recent years. However, its safety and efficacy in elderly patients with gastric cancer remain unclear. The aim of this study was to reveal the safety and efficacy of the ERAS protocol in elderly patients with gastric cancer. MethodsElderly gastric cancer patients (age≥70 years) who underwent gastrectomy were divided into the ERAS group and the conventional group. Postoperative complications, postoperative hospital stay, hospitalization expenses, and readmission rates were compared between the two groups. ResultsFrom December 2019 to January 2021, 100 eligible patients were enrolled in our study. All baseline data were balanced between the ERAS group and the conventional group. There was no significant difference in terms of complications (18% vs. 16%, P = 0.14) between the two groups. The most common complication was pneumonia. Four patients were observed in the conventional group and three patients in the ERAS group. The postoperative hospital stay was shorter in the ERAS group (8.2 vs. 10.4, P = 0.001). ConclusionsThe ERAS protocol could be safely used in elderly gastric cancer patients undergoing gastrectomy and shorten postoperative hospital stay.

Laparoscopic ureterolithotomy versus percutaneous nephrolithotomy for large proximal ureteral stones: a systematic review and meta-analysis.

Both percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU) are effective treatment options for large proximal ureteral stones. To perform a meta-analysis on this topic to assess the efficacy, safety, and potential complications of the two procedures. A systematic literature search was performed using PubMed, Ovid and Scopus to identify eligible suitable studies until May 2022. All studies comparing LU vs PCNL in large proximal ureteral stones were included. The Cochrane Collaboration's Review Manager (RevMan) 5.4 software was used to analyze statistical significance. A total of nine publications involving 933 patients (LU 465; PCNL 468) were included, of which 4 were randomized control trails (RCTs) and 5 were non-RCTs. The meta-analysis of available data showed that compared with PCNL, LU had a higher initial stone-free rate (OR = 3.26; p = 0.004), but longer operative time (WMD = 35.08 min; p = 0.0003). However, the final stone-free rate (OR = 2.08; p = 0.07) and length of hospital stay (WMD = 0.32 d; p = 0.48) were comparable between the two groups. Meanwhile, LU had a lower transfusion rate (OR = 0.13; p = 0.007) than PCNL. There was no significant difference in terms of complications (OR = 0.97; p = 0.84), Clavien-Dindo score ≥ 3 complications (OR = 1.03; p = 0.93), auxiliary procedures (OR = 0.44; p = 0.08), or ureteral stenosis (OR = 0.24; p = 0.13) between LU and PCNL. Our meta-analysis revealed that LU is a safe and feasible option for large proximal ureteral stones with a higher initial stone-free rate and lower transfusion rate compared with PCNL.

Efficacy of Nasal Continuous Positive Airway Pressure versus Heated Humidified High-Flow Nasal Cannula as a Primary Mode of Respiratory Support in Preterm Infants with RDS

Objective: To determine the efficacy of nasal continuous positive airway pressure (NCPAP) versus heated humidified high-flow nasal cannula (HHHFNC) as a primary mode of respiratory support in preterm infants with respiratory distress. Methodology: This randomized controlled trial study was conducted at in-patient department of neonatology (Nursery &amp; NICU) of Pakistan Insitute of Medical Sciences (PIMS) from July 2020 to Dec 2020. A total of 280 neonates randomly divided (140 in each study group) of both genders, with gestational age between 28-34 weeks and having mild-to-moderate respiratory distress within 1st 6 hours of birth requiring non-invasive ventilation were enrolled. Neonates in NCPAP Group (n=140) were given NCPAP whereas neonates in HHHFNC Group (n=140) were given HHHFNC. The efficacy of both groups were compared on the basis of treatment failure within 1st 3 days, total duration (hours) of non-invasive ventilator (NIV) required and total duration (hours) of supplementary oxygen required. Results: Overall, mean gestational age was noted to be 30.0+6.4 weeks. There were 144 (51.4%) neonates with birth weight between 1 to 1.4 kg, 90 (32.1%) between 1.5 to 1.9 kg and 46 (16.4%0 between 2.0 to 2.4 kg. Treatment failure was noted in 67 (47.6%) neonates in NCAP group while HHHFNC group reported 73 (52.4%) neonates with treatment failure (p=0.4733). No significant difference was observed in mean total duration of NIV support required (p=0.2598) or mean total duration of supplementary oxygen (p=0.1946) in between study groups. Conclusion: HHHFNC had similar efficacy when compared to NCPAP among neonates with RDS. In comparison to NCPAP, HHHFNC could be a simple, well-tolerated and effective alternative in terms of respiratory support. No major difference in terms of complication was observed between both treatment approaches.