Different Types Of Surgery Research Articles

SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery.

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complications or high degrees of BMI (> 40 Kg/m2), metabolic bariatric surgery can be a valid therapeutic option. Many different types of surgical procedures have been developed in last decades, mainly performed via laparoscopic approaches. However, clinical indications for metabolic and bariatric surgery (MBS) and the choice of the most appropriate type of procedure have not been clarified so far.The Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to design and develop the updated version of the Italian guidelines aimed at assisting healthcare professionals in the choice of the surgical option for the treatment of obesity and related conditions. Between June and October 2022, a panel of 24 experts and an evidence review team (ERT, 10 members), participated in the definition of clinical questions, outcomes, and recommendations and collected and analyzed all the available evidence on the basis of pre-specified search strategies. GRADE methodology and PICO (Patient, Intervention, Comparison, Outcome) conceptual framework have been adopted for the development of the present guidelines. Aim of the present guideline is to verify indications to surgery with respect to the presence of comorbid conditions, evaluate the different types of surgical approaches and endoscopic bariatric procedure and revise indication to revision surgery and postoperative procedures.

Ultrasound-guided minimally invasive cubital tunnel thread release: An experimental study.

Cubital Tunnel Syndrome is characterized by the compression of the ulnar nerve in the cubital tunnel and can cause restrictions to the activities of daily living. Traditional treatment includes conservative methods and, in more severe cases, different types of surgery. In these cases, common side effects of surgery may limit the clinical success. A new alternative could be a minimally invasive Ultrasound-guided (US-guided) thread release of cubital tunnel retinaculum also known as the Osborne's ligament. The aim of this study was to assess the efficacy and safety of ultrasound-guided thread cubital tunnel release (TCuTR) in an anatomical specimen model. In this single-center prospective experimental study, US-guided thread cubital tunnel release (TCuTR) was performed on 11 softly embalmed anatomic specimens. Subsequently, the elbows were dissected to assess the transection of Osborne's ligament and potential damage to adjacent structures. Due to calcification, one specimen was ineligible for the intervention. In all remaining ten interventions, Osborne's ligament (OL) was completely transected, without any damage to the surrounding nerves, blood vessels, tendons, or muscles. US-guided decompression has demonstrated a high success rate in transecting Osborne's ligament while averting damage to neighboring structures. This emerging technique appears to present an efficient and secure alternative to existing procedures.

REVIEW OF A CLINICAL CASE OF TRANSTROCHANTERIC FRACTURE

Introduction: Intertrochanteric or transtrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. A clinical case is described below from the time of the initial incident to the final ambulatory control and updated notes on the management of intertrochanteric fractures are made. Objective: to describe this clinical case objectively and to make an analysis of the subject. Methodology: An objective description of the clinical case and a review with analysis of a total of 17 articles, including review and original articles, as well as cases and clinical trials, of which 9 bibliographies were used because the information collected was not sufficiently important to be included in this study. The sources of information were Cochrane, PubMed and Google Scholar; the terms used to search for information in Spanish, Portuguese and English were: transtrochanteric fracture, femur fracture, intertrochanteric fracture, femur osteosynthesis. Results: the use of cephalomedullary nails reduces fracture collapse in comparison with the screwed plate. Cephalomedullary nails have been more effective in intertrochanteric fractures with subtrochanteric extension and in fractures with a reverse obliquity pattern. The type of surgical treatment is based on the fracture pattern and its inherent stability, since the failure rate is highly correlated with the choice of implant and fracture pattern. Conclusions: it is of utmost importance to know the proper management of a fractured patient, especially when the fracture is severe and life-threatening. The management of proximal femoral fractures will depend on their classification and the condition of the affected individual. Therefore, a good imaging study is essential. When deciding on a surgical approach, the material to choose in the procedures has to be ordered with planning and caution, because this will vary according to the type of fracture, being usual to perform different types of surgeries in intertrochanteric fractures being more common the use of intramedullary nails compared to femoral neck fractures, where it is more common the use of cannulated screws, or prosthesis depending on the type of fracture trace. Our clinical case gives a brief view on the surgical management of the pathology, which has to be understood for the best performance of the patient. KEY WORDS: fracture, transtrochanteric, femur, intertrochanteric.

Comparing oncological outcomes of robotic versus open surgery in the treatment of endometrial cancer.

Robotic surgery has been incorporated in the treatment of endometrial cancer, with evidence suggesting that minimal access surgery offers advantages over laparotomy including less blood loss, lower rate of perioperative complications, and accelerated postoperative recovery. The laparoscopic approach to cervical cancer (LACC) study has recently demonstrated inferior survival outcomes in cervical cancer patients treated with minimal access surgery including robotic surgery. It is, therefore, imperative that further evaluation of the latter in endometrial cancer is performed. A retrospective analysis of clinical data was performed. We compared two different types of surgery performed for the treatment of FIGO stage 1 to 3 endometrial cancer; open surgery performed in the years 2013-2015 vs robotic surgery performed in 2017-2019, after the implementation of the robotic program in our institution. Main outcome measures were recurrence-free survival and overall survival, with secondary outcomes including surgical morbidity and postoperative recovery. We compared 123 patients who had open surgery with 104 patients who underwent robotic surgery. One case from the second group was converted to open surgery due to the inability to complete it robotically. After a median follow-up of 68months, there was no difference in recurrence-free survival or overall survival between the two groups. Length of stay after an operation was significantly different with mean hospital stay of 1.6days after robotic surgery and 5days after open surgery (p = 0.001). No significant difference was identified in the rate of complications (p = 0.304). Our analysis has demonstrated that robotic surgery offers better perioperative outcomes without compromising the oncological safety.

Limited fasciectomy with versus without autologous adipose tissue grafting for treatment of Dupuytren’s contracture (REMEDY): study protocol for a multicentre randomised controlled trial

BackgroundDupuytren’s contracture is a hereditary disorder which causes progressive fibrosis of the palmar aponeurosis of the hand, resulting in digital flexion contractures of the affected rays. Limited fasciectomy is a standard surgical treatment for Dupuytren’s, and the one with the lowest recurrence rate; however, the recurrence is still relatively high (2–39%). Adipose-derived stem cells have been shown to inhibit Dupuytren’s myofibroblasts proliferation and contractility in vitro, as well as to improve scar quality and skin regeneration in different types of surgeries. Autologous adipose tissue grafting has already been investigated as an adjuvant treatment to percutaneous needle fasciotomy for Dupuytren’s contracture with good results, but it was only recently associated with limited fasciectomy. The purpose of REMEDY trial is to investigate if limited fasciectomy with autologous adipose tissue grafting would decrease recurrence compared to limited fasciectomy alone.MethodsThe REMEDY trial is a multi-centre open-label randomised controlled trial (RCT) with 1:1 allocation ratio. Participants (n = 150) will be randomised into two groups, limited fasciectomy with autologous adipose tissue grafting versus limited fasciectomy alone. The primary outcome is the recurrence of Dupuytren’s contracture on any of the treated rays at 2 years postoperatively. The secondary outcomes are recurrence at 3 and 5 years, scar quality, complications, occurrence of algodystrophy (complex regional pain syndrome), patient-reported hand function, and hypodermal adipose tissue loss at 1 year postoperatively in a small subset of patients.DiscussionThe REMEDY trial is one of the first studies investigating limited fasciectomy associated with autologous adipose tissue grafting for Dupuytren’s contracture, and, to our knowledge, the first one investigating long-term outcomes of this treatment. It will provide insight into possible benefits of combining adipose tissue grafting with limited fasciectomy, such as lower recurrence rate and improvement of scar quality.Trial registrationClinicalTrials.gov NCT05067764, June 13, 2022.

Successful Treatment of Granuloma Annulare with Tapinarof 1% Cream: A Case Report

Peritoneal Metastasis (PM) is a common site of dissemination of gastric cancer. PM remains a major cause of mortality and is associated with poor prognosis. For this reason the last 30 years the treatment of peritoneal disease is an important target for improving survival. The therapeutic approaches of locoregional therapy for GCPM include different types of surgery and different types of intraperitoneal chemotherapy. This review presents an overview of these modalities and summarizes the evolution of management the last years. It highlights in controversial options which existing in literature and focuses in the ongoing clinical trials that will help establish the role of locoregional treatments in GCPM.

Huaxi integrated blood management reduces the red blood cell transfusion for on-pump cardiac surgery: A quasi-experimental study

ObjectiveAs many as half of patients undergoing on-pump cardiac surgery require red blood cell transfusion, emphasizing the need for effective strategies that can reduce this need. We conducted this analysis to assess the effectiveness of Huaxi Integrated Blood Management strategy at our medical center. DesignBefore and after study. ParticipantsPatients who underwent on-pump cardiac surgery were included from January 2019 to December 2021. Two cohorts were compared, one before implementation of the strategy (1 January 2019 until 31 May 2020) and one after implementation (1 June 2020 until 31 December 2021). MeasurementsWe evaluated temporal trends in blood transfusion, safety, and efficacy of this strategy. Primary outcomes were the incidence and volume of intra- and postoperative blood transfusions of packed red blood cells. Secondary outcomes are intraoperative and postoperative transfusion of other blood products, all-cause mortality during hospitalization, and incidence of new-onset complications. Main resultsOur results demonstrated that this integrated strategy effectively decreased both the perioperative packed red blood cell transfusion volume and incidence for patients who underwent the on-pump cardiac surgery. Following the implementation, the incidence of packed red blood cell transfusions decreased by 8.1% during the intraoperative period and by 12.3% during the postoperative period. The mean volume of such transfusions decreased by 0.28 units during the intraoperative period and by 0.49 units during the postoperative period. Hemoglobin concentrations were significantly higher after implementation, and the maximal mean increase was 4.72 g/l on postoperative day 1. Similar benefit of the strategy was observed across subgroups of patients who underwent different types of surgery. ConclusionsThe Huaxi Integrated Blood Management strategy may be effective at reducing the need for packed red blood cell transfusion and enhancing patient care.

Analysis of Various Laparoscopic Pediatric Urology Surgeries: Five-Year Experience of a Single Institution.

Background In this study, we aim to report our single-center experience with laparoscopic pediatric urological surgeries. We aim to determine the feasibility of various urological and urogenital laparoscopic procedures and the tricks that increase surgical success. Methodology Data from 98 patients who underwent laparoscopic urological and/or urogenital procedures for diagnostic and therapeutic purposes in our clinic between June 2018 and February 2023 were retrospectively analyzed. All surgeries were performed by the same surgical team. Laparoscopic procedures included orchidopexy, gonadectomy, vaginoplasty, hysterectomy, pyeloplasty, nephrectomy/partial nephrectomy, ureteroneocystostomy, bladder diverticulum excision, renal cyst excision, proximal ureter stone removal, oophorectomy, ovarian detorsion, oophoropexy, and lymph node excision for diagnostic purposes. The surgical planning of the patients was based on the decisions of the pediatric nephrology, pediatric endocrinology, and pediatric oncology departments and the multidisciplinary council. Demographic characteristics of the patients, surgical indications, and intraoperative data, as well as postoperative pathological diagnoses and complications, were recorded. All patients underwent a transperitoneal approach. The duration of the operation was obtained from anesthesia records and defined as the time from the beginning of the surgical incision to the closure of the skin incision. Results Of the patients, 54 were males and 44 were females. The median age was 7.8 years. No complications other than grade 1 according to the Clavien-Dindo classification were observed in our patients. As different types of surgeries were analyzed, the mean operative duration was estimated. Conclusions The laparoscopic method should be performed by surgeons experienced in advanced surgeries in pediatric urology. It is critical to consider the difference in the size of pediatric patients in preparation for laparoscopic surgery to minimize technical and ergonomic problems. We believe that each surgery has its specific tricks and that these should be a part of laparoscopy training. Moreover, developing and sharing this information would be very useful for pediatric urologists.

Erector spinae plane block with ropivacaine 0.2% in children: a single-centre case series in a tertiary paediatric centre in Malaysia

Erector spinae plane block (ESPB) was first described in 2016 by Forero et al. as a modified interfascial plane block used for patients with chronic neuropathic thoracic pain. It was applied in the paediatric population for postoperative pain management as early as 2017. Most evidence on the efficacy of ESPB as postoperative analgesia in the literature is mainly found in case reports, but very few trials had been conducted. This case series describes 4 paediatric patients who received ESPB as part of multimodal analgesia while undergoing different types of surgery,i.e., 1 Kasai procedure, 1 closure of stoma, and 2 thoracotomies. All 4 patients had general anaesthesia for the surgery. No complications were observed in relation to the regional anaesthetic technique. Pain control was achieved with a pain score of 0–2 for 3 patients and 2–4 for 1 patient (thoracotomy) on Day 1 postoperatively, while all of them a had pain score of 0–2 on postoperative Day 2. We found ESPB with ropivacaine 0.2% to be a safe and effective analgesia as part of multimodal management of postoperative surgical pain. Further studies are needed to validate this observation.

Public Preferences for Surgeon Gender in Saudi Arabia: A Cross-Sectional Analysis.

Gender equity in healthcare ensures equal access to services and resources for all individuals, regardless of gender. Studies show that patients' gender influences their healthcare experiences and decisions, and societal gender preferences impact surgeon selection. Therefore, the objective of this study was to address the surgeons' gender preferences among Saudi Arabia's population. This study used a cross-sectional research design and survey methodology to gather data from a representative sample of adults aged 18 and older from the general population in Saudi Arabia. This study used SPSS version 26 for statistical data entry and analysis, employing descriptive and inferential statistics, frequency distributions, descriptive statistics, and multivariate analysis using multiple logistic regression for variables significantly associated with population gender in univariate analysis. This study involved 2085 participants, with 51.2% aged 18-25, 18.4% aged 26-35, 16.7% aged 36-45, and 13.8% aged 45 and above. The majority were Saudi Arabian, with a majority holding a university degree. The majority worked in the healthcare sector, while the remaining 29.7% were unemployed. This study found that there were significant gender preferences among survey respondents for different types of surgical procedures. Male participants preferred male surgeons for routine non-emergency visits and sensitive obstetric, genital, sexual, and minor procedures (p < 0.001). Female participants, on the other hand, had no preference for emergency surgeries and major surgical procedures (p < 0.001). This study found that participants were more likely to prefer female surgeons for regular non-emergency visits to the surgery clinic (p < 0.001; aOR = 2.344). Additionally, participants had a high preference for female surgeons for sensitive cases (p < 0.001; aOR = 7.064) and minor surgical procedures (p < 0.001; aOR = 2.489). This study underscores the significance of cognizance and the incorporation of a patient's gender preferences when selecting surgical procedures, thus fostering an environment that is more accommodating and focused on the patient.

Influence of patient characteristics on microbial composition in surgical-site infections: insights from national surveillance study.

Although the impact of surgery- and patient-dependent factors on surgical-site infections (SSIs) have been studied extensively, their influence on the microbial composition of SSI remains unexplored. The aim of this study was to identify patient-dependent predictors of the microbial composition of SSIs across different types of surgery. This retrospective cohort study included 538 893 patients from the Swiss national infection surveillance programme. Multilabel classification methods, adaptive boosting and Gaussian Naive Bayes were employed to identify predictors of the microbial composition of SSIs using 20 features, including sex, age, BMI, duration of surgery, type of surgery, and surgical antimicrobial prophylaxis. Overall, SSIs were recorded in 18 642 patients (3.8%) and, of these, 10 632 had microbiological wound swabs available. The most common pathogens identified in SSIs were Enterobacterales (57%), Staphylococcus spp. (31%), and Enterococcus spp. (28%). Age (mean feature importance 0.260, 95% c.i. 0.209 to 0.309), BMI (0.224, 0.177 to 0.271), and duration of surgery (0.221, 0.180 to 0.269) were strong and independent predictors of the microbial composition of SSIs. Increasing age and duration of surgical procedure as well as decreasing BMI were associated with a shift from Staphylococcus spp. to Enterobacterales and Enterococcus spp. An online application of the machine learning model is available for validation in other healthcare systems. Age, BMI, and duration of surgery were key predictors of the microbial composition of SSI, irrespective of the type of surgery, demonstrating the relevance of patient-dependent factors to the pathogenesis of SSIs.

Simultaneous operations in patients with colorectal cancer with liver metastases.

e15586 Background: Metastatic colorectal cancer (CRC) treatment is a complex process involving surgical oncologists, chemotherapy specialists, and radiation oncologists. Objective: To assess the long-term outcomes of treating patients with metastatic CRC who has gone through simultaneous liver operations. Methods: Data and medical records of 61 patients with primary metastatic CRC treated at the Republican Specialized Scientific-Practical Center of Oncology and Radiology of the Republic of Uzbekistan between 2016 and 2020 were reviewed. Disease diagnosis and treatment were conducted following the current recommendations of the Ministry of Health of the Republic of Uzbekistan. The median follow-up period was 35 months. Results: The mean age of the patients included in the study was 59.1 years (ranging from 36 to 81 years). Of them, 32 male and 29 female patients. Metastatic cancer of the rectum was diagnosed in 18 patients (29.5%), rectosigmoid junction in 9 (14.8%), and colon in 34 (55.7%). Among the patients, 3 had low-grade tumor differentiation, 24 had medium-grade, and 34 had high-grade. According to the "T" criterion, 65.6% of the tumors were categorized as T3, 29.5% as T4, and 4.9% as T2. Different types of surgeries were performed for primary tumor localization, including abdominoperineal resection of the rectum (2 patients), right hemicolectomy (10 patients), rectal resection (5 patients), rectosigmoid junction resection (4 patients), colon resection (6 patients), left hemicolectomy (5 patients), and transabdominal rectal resection (4 patients). Postoperative complications were observed in 16 patients (bile leakage from drainage, wound suppuration, pneumonia, bladder atony). Anastomotic complications were detected in 2 patients. There were no deaths in the early postoperative period. The median overall survival was 36 months. The one-year overall survival rate in the overall group was 91.7% ± 3.7%, two-year - 76.2% ± 5.6%, three-year - 51.9% ± 7.5%. For colon cancer, the three-year overall survival was 62.7% ± 9.3%, rectosigmoid junction - 43.2% ± 20.8%, rectal cancer - 36.8% ± 13.7 (p = 0.974). Conclusions: Simultaneous operations for CRC and liver metastases combined with combination therapy contribute to stabilizing the tumor process and increasing overall survival rates.

An analysis of treatment trends in sclerosing epithelioid fibrosarcoma.

e23547 Background: Sclerosing Epithelioid Fibrosarcoma (SEF) is a rare, malignant, soft tissue sarcoma found in the arms, legs, head, and neck. Histologically, SEF is characterized by a distinctive architecture composed of cords, nests, and/or sheets of uniform epithelioid cells. Previous studies have demonstrated that surgery with wide surgical margins is associated with superior outcomes in SEF patients. However, on account of the rare nature of SEF, insufficient research has been conducted on the association of treatment types with long-term survival. Using the National Cancer Database (NCDB), this study analyzed the receipt of different types of surgery and adjuvant treatments on the overall survival of patients with SEF. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with SEF from 2004 to 2020 using histology code 8840 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: Out of the 1226 patients with SEF, 1088 patients ( 88.7%) received a tumor resection at the primary site. Receipt of surgery was associated with a greater median overall survival compared to not receiving surgery ( 123.6 months vs 45.7 months; p &lt; 0.05). Of the surgical patients, 419 patients received a wedge/segmental resection ( 38.5%) and 609 patients received a lobectomy ( 56%). Wedge/segmental resections and lobectomy had improved outcomes compared to other surgery types ( p &lt; 0.001). In addition to tumor resection, 140 patients ( 12.9%) received adjuvant chemotherapy, 21 patients ( 1.9%) received adjuvant radiation, and 11(1%) patients received adjuvant chemoradiation. Furthermore, the receipt of adjuvant therapies including adjuvant chemo, adjuvant radiation, and adjuvant chemoradiation, was associated with improved overall survival compared to receiving surgery alone ( p = 0.03; p = 0.005; p &lt; 0.001, respectively). Patients who received adjuvant chemoradiation experienced 9.5 months longer median survival time than patients who received adjuvant chemotherapy ( p &lt; 0.001). Conclusions: SEF patients who received tumor resection had a marked increase in overall survival. Receiving wedge/segmental and lobectomy surgery types were associated with improved patient outcomes compared to other surgery types. Furthermore, receiving any adjuvant therapy was associated with improved overall survival compared to receiving surgery alone. Receiving adjuvant chemoradiation was associated with superior outcomes in SEF patients compared to receiving other adjuvant therapies and surgery alone. To improve overall survival in SEF patients, further research is needed to assess what factors influence treatment trends.

Is there an impact of a video-based patient informed consent in elective hand surgery?

BackgroundPatient informed consent is a crucial subject in preoperative care of patients before elective hand surgery, ensuring that patients have the necessary information and a comprehensive understanding to make autonomous decisions. The use of video-based informed consent systems is an innovative concept to enhance the consent process with multimedia tools. In addition to the conventional process, mostly relying on verbal communication and written documents, the video-based approach aims to present information in a standardized and visually appealing format.MethodsIn this study, 33 patients were asked to watch a video on a tablet about the planned elective hand surgery after a conventional pre-treatment consultation including informed consent throughout verbal explanations and paper forms by an attending physician or resident. All patients were asked to complete a questionnaire after watching the video.ResultsAn overwhelming majority of participants, specifically 97.0%, stated that the video improved their understanding of the upcoming surgery. 90.9% of the participant would refer the video to other patients undergoing elective hand surgery, while 72.7% of participants indicated that they would have appreciated the opportunity to view an informational video before undergoing different types of surgeries in the past.ConclusionThe use of a video-based patient information system in elective hand surgery had a positive impact on patient education and satisfaction with the informed consent process. Therefore, it is a powerful tool in preoperative management to guarantee a standardized and educative informed consent.

Profile and Prevalence of Oral and Maxillofacial Diseases Among Armed Forces Personnel and Their Families in Military Dental Centre, Cumilla

Background: Oral and maxillofacial diseases encompass a wide range of conditions in and around oral cavity and in maxillofacial region. It includes maxillofacial trauma, cyst and tumour of jaw bones, conditions involving impacted wisdom teeth, oral premalignant and malignant lesions, fascial space infection around maxillofacial region, temporomandibular joint disorder, dental implantology, salivary gland disorder and congenital defects of jaw bones. Maxillofacial region is more vulnerable to sustain injuries in the battlefield. In peace time, various maxillofacial diseases reduce the overall performances of the troops. The aim of this study is to delineate rank wise distribution of armed forces personnel reported with maxillofacial diseases, gender distribution, types of maxillofacial diseases, different types of surgical procedures performed and types of anesthesia used. Methods: A descriptive cross-sectional study was conducted to assess the prevalence of maxillofacial diseases among the armed forces personnel and their entitled family members during the period of 1st January 2019 to 31st December 2019 in Military Dental Centre, Cumilla. Purposive sampling technique and semi structured questionnaire was used to include the patients in this study.Data were analyzed by using Statistical Packages for Social Sciences (SPSS) version 25. Results: A total of 170 cases were evaluated and treated. Male patients were 110(65%) and female were 60(35%). Among the military personnel numbers of sainik (privates) were highest 32(35%). Impacted wisdom teeth cases were mostly found 80(47%). In case of impacted teeth mesio angular impactions were most 35(35%). In case of maxillofacial pathological conditions cystic lesions were most in number 22(39%) (n=56). Maxillofacial soft tissue laceration cases were highest 05(29%) (n=17) among all trauma patients. Surgical extraction of wisdom teeth were mostly performed surgery 80(59%) (n=138). In regards to administration of anesthesia, 128(93%) cases were performed under local anesthesia and 10(7%) were under general anesthesia. Conclusion: The present study imparts valuable perception about the types and prevalence of maxillofacial diseases and the treatment modalities among the armed forces personnel and their families in Cumilla area. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 24-30

Factors contributing to weight loss success after bariatric procedures in patient over 65 years old: a multicenter retrospective cohort study.

Although bariatric surgery in patients over 65 years of age gives comparable results to treatment in the younger population, there are still controversies regarding the indications for surgery, risk assessment, and choice between different types of surgery. The study aimed to identify the factors contributing to weight loss success after bariatric surgery in patients over 65 years of age. This is a retrospective, multicenter cohort study of patients with obesity aged over 65 years undergoing primary laparoscopic bariatric surgery in the years 2008-2022. Data came from 11 bariatric centers. Patients were divided into two groups: responders (R) who achieved more than 50% EWL and nonresponders (NR) who achieved less than 50% EWL. Both groups were compared. Uni- and multivariate logistic regression was used to identify predictors of weight loss success. Out of 274 analyzed patients, the average BMI before surgery was 42.9kg/m 2 . The most common obesity-related diseases were hypertension (85.1%) and type 2 diabetes (53.3%). Sleeve gastrectomy was the most frequently performed procedure (85.4%). Uni- and multivariate logistic regression analysis confirmed preoperative BMI (OR=0.9, 95% CI: 0.82-0.98, P =0.02), duration of diabetes >10 years (OR=0.3, 95% CI: 0.09-0.82, P =0.02), balloon placement (OR=10.6, 95% CI: 1.33-84.83, P =0.03), time since first visit (OR=0.9, 95% CI: 0.84-0.99, P =0.04), preoperative weight loss (OR=0.9, 95% CI: 0.86-0.98, P =0.01), and OAGB (OR=15.7, 95% CI: 1.71-143.99, P =0.02) to have a significant impact on weight loss success 1 year after bariatric surgery. Patients with higher preoperative weight loss may have a poorer response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. Intragastric balloon placement before surgery may be effective in patients above 65 years of age and may be considered as a two-stage approach.

Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting: A Surgical Technique.

In recent years, there has been a growing interest in robotic-assisted coronary artery revascularization in Europe. Two different types of surgery can be performed using a robotic platform: RA-MIDCAB, in which the mammary artery is harvested endoscopically with robotic assistance and off-pump bypass graft is achieved under direct vision through mini thoracotomy, and TE-CAB, completely robotically performed. We started the robotic cardiac surgery program for mitral valve disease in our hospital, Humanitas Gavazzeni (Bergamo, Italy), in 2019; and in 2021, we addressed our experience with RA-MIDCAB. After a learning curve period, we have developed our technique to optimize the benefits offered by the robotic platform, tailoring strategy to individual patients, based on preoperative radiological images.

Early Exercise Through Telerehabilitation After Bariatric Surgery: Is It Feasible?

The feasibility of early telerehabilitation after bariatric surgery is unknown. The objective of this study was to assess the feasibility and perception of engaging in the online exercise protocol in patients during the first month after bariatric surgery. A total of 67 patients, enrolled in a telerehabilitation program following bariatric surgery, completed a survey assessing their perception of the intensity, discomfort, and safety during exercise sessions. Forty percent of participants began exercising between 5 and 10days after surgery. Seventy-one percent of patients did not experience discomfort during the first month of exercise, and those who reported discomfort mainly mentioned dizziness and abdominal pain. No significant differences were found in the presence of discomfort among different types of surgeries performed. There was a significant difference in the presence of discomfort between patients who started exercising before and after 15days of surgery, with less discomfort reported in the group that started after 15days. Ninety-eight percent of patients felt safe during online exercise sessions. Most participants perceived the intensity of the sessions as moderate. The most frequently mentioned benefits of exercise were increased energy, mood, and feeling more active. Telerehabilitation conducted during the first month after bariatric surgery was feasible and well tolerated by patients, providing a safe alternative for those patients who face difficulties with in-person interventions.

AI As the New Age Estimator: Pioneering Customized Facial Surgery Outcomes

Abstract Goals/Purpose The imperative for precision in aesthetic surgery necessitates a robust framework for evaluating the impact of facial interventions on perceived age. Our study introduces a cutting-edge AI model aimed at discerning an individual's perceived age from facial characteristics. This tool is designed to augment the assessment of various plastic surgery procedures, facilitating the tailoring of interventions to each patient's unique facial aging pattern. Methods/Technique We harnessed a deep convolutional neural network (DCNN), pre-trained on the extensive ImageNet dataset, and further refined using 523,051 pre-annotated facial images from the IMBD-WIKI database, normalized as per the Mathias et al. face detection paradigm. Faces were processed into a 299x299 pixel matrix, maintaining a 40% margin around the face for uniformity. The Xception architecture was employed for its advanced feature extraction capabilities. The model was refined and tested against a diverse set of 100 patient faces from the Mayo Clinic's database, categorized by demographic and procedural data. The AI model employed regression analysis and softmax probability for precise age estimation. Results/Complications The AI model exhibited a remarkable accuracy rate of 92.5% in age estimation for pre procedural patients, with a standard deviation of 3.2 years. It significantly outperformed traditional methods in identifying fine-grained age-related features. The AI model discerned an average perceived age reduction of 3.5 years across all patients post-procedure, with a notable variance among different types of surgeries. Certain procedures, such as rhytidectomy and blepharoplasty, showed a more pronounced age-reduction effect. Conclusion The AI model presents an accurate and objective method for quantifying perceived age, serving as a significant benchmark in facial aesthetic evaluation. By illustrating measurable age reduction following various procedures, with some surgeries yielding more substantial changes in perceived age, the model stands as a testament to the effectiveness of plastic surgery interventions. The precision of our model in predicting age pre- and post-procedure underscores its potential to assist surgeons in custom-tailoring surgeries to individual aging patterns. This innovation is poised to refine the decision-making process in aesthetic surgery, ensuring treatments are aligned with the desired outcomes for rejuvenation and patient-specific needs, ultimately advancing the frontier of personalized plastic surgery.

Comparing long-term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran.

Hypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life-threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long-term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries. This was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in-hospital and long-term outcomes were reported and compared between the three groups. A total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty-six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8-year follow-up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups. Isolated septal myectomy showed better long-term survival rates and can correct HCM-related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM.