Different Types Of Surgery Research Articles

Less extensive surgery for patients with FIGO stage IA2 cervical cancer: A population-based study

ObjectivesThe objectives of this study were to study the feasibility of less extensive surgeries for stage IA2 cervical cancer and to examine the incidence of positive nodes in stage IA2 cervical cancer. MethodsPatients with stage IA2 cervical cancer treated surgically between 1998 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and cervical cancer-specific survival (CCSS) were compared among patients who underwent different types of surgery (simple hysterectomy VS radical hysterectomy, lymphadenectomy VS without lymphadenectomy). The Cox proportional hazards regression model was applied to evaluate multiple prognostic factors. Results1343 patients were included in this study. The overall incidence of positive nodes in stage IA2 was 2.53%. For well-differentiated IA2 cervical cancer, the incidence of regional lymph node involvement was as low as 1.42%. Compared with patients who underwent lymphadenectomy, the patients who did not undergo lymphadenectomy had the same OS (HR, 1.336; 95% CI, 0.923 to 1.933; P = 0.149) and CCSS (HR, 1.038; 95% CI, 0.504 to 2.140; P = 0.920). The log-rank test also indicated that simple hysterectomy was not associated with decreased OS (HR, 1.048; 95% CI, 0.750 to 1.466; P = 0.781) and CCSS (HR, 1.259; 95% CI, 0.655 to 2.420; P = 0.490). Multivariable analyses showed that lymphadenectomy and type of hysterectomy were not independent predictors of survival for patients with stage IA2 cervical cancer. ConclusionsThe incidence of nodal involvement in well-differentiated stage IA2 cervical cancer was fairly low, lymphadenectomy may be omitted in these patients. The excision range of parametrial tissue was not associated with the oncological survival of women with stage IA2 cervical cancer, simple hysterectomy may be an appropriate alternative for this group of patients.

Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta-analysis.

Opioid-based treatment is used to manage stress responses during surgery and postoperative pain. However, opioids have both acute and long-term side effects, calling for opioid-free anaesthetic strategies. This meta-analysis compares adverse events, postoperative recovery, discharge time from post-anaesthesia care unit, and postoperative pain, nausea, vomiting, and opioid consumption between strict opioid-free and opioid-based general anaesthesia. We conducted a systematic review and meta-analysis. We searched PubMed, Embase, Cinahl, Cochrane Library, selected reference lists, and Google Scholar. We included randomised controlled trials (RCTs) published between January 2000 and February 2021 with at least one opioid-free study arm, i.e. no opioids administered preoperatively, during anaesthesia induction, before skin closure, or before emergence from anaesthesia. The study comprised 1934 patients from 26 RCTs. Common interventions included laparoscopic gynaecological surgery, upper gastrointestinal surgery, and breast surgery. There is firm evidence that opioid-free anaesthesia significantly reduced adverse postoperative events (OR 0.32, 95% CI 0.22 to 0.46, I2 =56%, p<0.00001), mainly driven by decreased nausea (OR 0.27, (0.17 to 0.42), p<0.00001) and vomiting (OR 0.22 (0.11 to 0.41), p<0.00001). Postoperative opioid consumption was significantly lower in the opioid-free group (-6.00mg (-8.52 to -3.48), p<0.00001). There was no significant difference in length of post-anaesthesia care unit stay and overall postoperative pain between groups. Opioid-free anaesthesia can improve postoperative outcomes in several surgical settings without evidence of adverse effects on patient safety and pain management. There is a need for more evidence-based non-opioid anaesthetic protocols for different types of surgery as well as postoperative phases.

Prospective analysis of post-operative pain management in elective laparotomies in a tertiary care centre

Background: The study was conducted to record the drug used for postoperative pain in elective laparotomies and to determine the effectiveness of multimodal analgesics used.Methods: A prospective observational study for a period of 15 months from March 2019 to May 2020 in 140 patients who underwent elective laparotomies from the department of general surgery Rajarajeswari medical college and hospital (tertiary care center).Results: A total of 140 patients were included among which 58 (41.4%) were female and 82 (58.6%) were male patients. The 20 different types of surgeries were recorded. In our study the most common surgery performed was open appendectomy followed by open cholecystectomy. Most common mode of analgesia used was combined analgesia. Opioids, NSAIDS (non-steroidal anti-inflammatory drugs), epidural and transdermal patch was used. NRS (numerical rating scale) score was recorded for all 140 patients on postoperative days 1, 2 and 3.Conclusions: Combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

Gait Analysis Platform for Measuring Surgery Recovery.

Gait analysis has evolved significantly during last years due to the great development of the Medical Internet of Things (MIoT) platforms that allow an easy integration of sensors (inertial, magnetic and pressure in our case) to the complex analytics required to compute, not only relevant parameters, but also meaningful indexes. In this paper, we extend a previous development based on a fully wireless pair of insoles by implementing an updated version with more reliable and user-friendly devices, smartphone app and web front-end and back-end. We also extend previous work focused on fall analysis (with the corresponding fall risk index or FRI) with the proposal of a new surgery recovery index (SRI) to account for the individual speed recovery speed that can be measured either at clinical facilities or at home in a telemedicine environment or while doing daily life activities. This new index can be personalized for different types of surgeries that affect gait such as hip, knee, etc. This paper presents the case of hip recovery and is built on top of the clinical standard SPPB test and allows obtaining quantitative parameters directly from the sensors.

The Valero Tip and Attachment for Cooper Surgical Rumi Uterine Manipulator

<h3>Study Objective</h3> To produce a Stainless-Steel surgical degree tip and attachment that works with uterine manipulator and allows the use of cervical cup for different types of surgeries. - Plastic pollution continue to be a serious problem for human health and environment, it's estimate that for 2030, 53 million tonnes of plastic could end up in rivers, lakes and oceans. One example of how changing consumption patterns can improve the environment is the use and disposal of plastics. The global theme of World Environment Day is "Beat Plastic Pollution". It aims to change consumer behaviour with the challenge, "If you can't reuse it, refuse it." In OR we don't have exception, for reducing Medical Waste and optimizing our ORs for the future, we design a stainless-steel surgical degree tip and attachment for the uterine manipulator. <h3>Design</h3> We produce a 3-D Model plastic tip as a prototype, subsequently a stainless-steel tip and attachment <h3>Setting</h3> Like it adapts to a uterine manipulator, patient position is lithotomy, the Tip attaches by a "ring" then allows the use of a cervical cup that adapts to the ring. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The design patent pending through the School of Medicine and Engineer, attach to the three types of uterine manipulator also it allows to use the cervical cup and provides the ability to use it in hysterectomy or other procedures without the cervical cup. Base on this we present the prototype guide and assemble. <h3>Conclusion</h3> The reestirilization of the tip allows us not promote the use of plastic waste.

Evaluating perioperative glycemic status after different types of pancreatic surgeries via continuous glucose monitoring system: a pilot study.

Perioperative glycemic status after pancreatic surgery has never been described. However, it's essential for optimal perioperative glucose management and understanding the pathogenesis of new-onset diabetes mellitus (NODM) after pancreatectomy. Continuous glucose monitoring (CGM) system provides us a helpful tool for closely monitoring and studying perioperative glucose change. This study tried to describe and compare perioperative glucose level and glycemic variability between different types of pancreatic surgeries via CGM device. This study was designed as a prospective observational study. Eighteen patients were enrolled and were grouped by different types of surgery received: control group (CTRL), pancreaticoduodenectomy (PD), distal pancreatectomy (DP), and total pancreatectomy (TP). CGM devices were implanted and initiated right after the surgery. Mean glucose value (MGV), coefficient of variation (CV), mean of daily difference (MODD), continuous overall net glycemic action (CONGA), and time above range (TAR)/time below range (TBR) was compared between groups to assess glucose level and glycemic variability. TP showed the highest MGV and CV among all groups (P<0.001), while CTRL showed the lowest (P<0.001). PD and DP had similar MGV and CV lower than TP but higher than CTRL (P<0.001). TP had the highest MODD and CONGA, CTRL had the lowest, but no significant differences were found between groups. TP had the highest TAR (24.29%) and the lowest TBR (1.28%), while the control group showed the opposite. The differences in TAR/TBR between groups were all significant (P<0.05). TP had the highest mean glucose level and the greatest glycemic variability. PD and DP had similar results: a higher mean glucose level than control but lower than TP. For glycemic variability, PD and DP seemed to have a near-normal result resembling the control group. CGM is useful for glucose monitoring in the perioperative management of pancreatic surgery.

Treatment of Benign Lesion of Levels I or II of the Parotid Gland: Long Term Results of Partial Superficial Parotidectomy.

The correct surgical approach to benign parotid gland tumors is still matter of debate, it should be chosen considering the possibility of local recurrence or facial nerve complications in case of "not necessary" facial nerve dissection. In the era of minimally invasive surgery, more sparing approaches such as extracapsular dissection or partial superficial parotidectomy (PSP) are gaining popularity. The aim of the study is to present surgical results and long-term outcomes of PSP (level i or ii) in a large group of patients. Six hundred fifty-one patients who underwent parotid surgery between 2004 and 2020 were initially considered. Five hundred forty patients with benign lesions treated with PSP, enucleation, ECD were enrolled. Clinical features, surgical data, postoperative scarring, seroma, dehiscence, neuroma, outcomes as Frey syndrome, and delayed facial nerve dysfunction have been evaluated. 65.5% PSP, 25.2% enucleation, and 9.2% extracapsular dissection. No statistical difference in surgical time has been found (P 0.16). P > 0.05 for seroma, neuroma, Frey syndrome, and facial palsy between different type of surgery. Frey syndrome in PSP: 6/135 (4.4%) in 2004 to 2012 and 2/219 (0.9%) in 2013 to 2020. The reduction between periods is significant (P < 0.04). Recurrence: 0.8% (3/354) for PSP patients, 3.4% (5/ 136) in enucleation and 10% (5/50) in ECD (P = 0.02). Partial superficial parotidectomy can be considered a minimally invasive and quick procedure with low complication rate. Our data seem to support this statement (large case series and long-term follow-up).

Under the knife: Unfavorable perceptions of women who seek plastic surgery.

Plastic surgery is growing in popularity. Despite this, there has been little exploration to date regarding the psychosocial consequences of seeking plastic surgery. Our study investigated how women seeking plastic surgery are perceived by others. We presented a random sample of 985 adults (men = 54%, Mage = 35.84 years, SDage = 10.59) recruited via Amazon's Mechanical Turk with a series of experimental stimuli consisting of a photographed woman (attractive versus unattractive) and a vignette describing an activity she plans to engage in (plastic surgery versus control activity). Participants rated stimuli on perceived warmth, competence, morality, and humanness. We ran linear mixed-effect models to assess all study hypotheses. There was a negative plastic surgery effect; that is, women seeking plastic surgery were perceived less favorably than those planning to complete control activities across all outcome variables (warmth, competence, morality, and humanness). These relationships were moderated by physical attractiveness; while attractive women planning to undergo plastic surgery were perceived less favorably than attractive women planning to engage in control activities, perceptions of unattractive individuals remained unchanged by plastic surgery status. We theorized that empathy toward unattractive women seeking plastic surgery mitigated the negative plastic surgery effect for these women. In sum, our results suggest that perceptions of attractive women are worsened when these women decide to seek cosmetic surgery. Perceptions of warmth and competence have implications for an individual's self-esteem and interpersonal relationships, while perceptions of morality and humanness can impact an individual's ability to fulfil their psychological needs. As such, we concluded that attractive women seeking plastic surgery are potentially subject to experience negative psychosocial outcomes. Future research ought to examine whether perceptions and outcomes differ for women seeking reconstructive plastic surgery (versus cosmetic plastic surgery) and whether they differ across different types of surgeries (i.e. face versus body).

Differences of 2-year longitudinal changes of locomotive syndrome among patients treated with thoracolumbar interbody fusion, total hip arthroplasty, and total knee arthroplasty for degenerative diseases.

To clarify the longitudinal changes in patients with preoperative Stage-3 locomotive syndrome (LS) according to different types of surgeries, we investigated the changes in the LS stage in patients who underwent surgery for degenerative musculoskeletal diseases. A prospective cohort study was conducted on 168 patients with degenerative diseases [46 spinal deformities treated with thoracolumbar interbody fusion (T/LIF), 86 hips with osteoarthritis treated with total hip arthroplasty (THA), and 36 knees with osteoarthritis treated with total knee arthroplasty (TKA)]. The results for the LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25) were evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Preoperatively, most patients had Stage-3 LS (89.1, 90.8, and 80.6% in the T/LIF, THA, and TKA groups, respectively). At 2 years postoperatively, the Stage-3 LS improved in 41.5, 75.6, and 55.2% of patients in the T/LIF, THA, and TKA groups, respectively. All groups showed similar improvements in the two-step test. The THA group showed the best result in the GLFS-25. LS stage improved in different patterns over 2 years postoperatively and the LS risk test revealed differences in postoperative movement ability according to the type of surgery.

IMPACT OF SURGERY ON OVARIAN RESERVE IN PATIENTS WITH ENDOMETRIOMA AMONG INFERTILE WOMEN

To find out the correlation between pre-operative serum AMH and FSH levels and 3 months post-operative levels. The study was conducted in the Reproductive Endocrinology and Infertility Unit of Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh, during July 2018 to December 2019. All admitted patients diagnosed with ovarian endometriomas (>4 cm) and of 20-35 years of age were included. Laparoscopy was the mainstay of surgery but in a few cases laparoscopy followed by laparotomy was done. Cystectomy (complete excision of the capsule) was attempted and adhesiolysis was also performed. Electrocoagulation was needed in few cases for haemostasis, which was performed by monopolar or bipolar diathermy. Carbon dioxide laser vaporization was not available, and cyst drainage was not done. In open cases, reconstruction of the ovary was performed. This study was a descriptive cross-sectional study. Initially for all patients, Serum AMH levels were measured preoperatively. Three months post surgery, Serum AMH was measured again, and data analysis and comparison of these values with ovarian reserve was done. Change in Serum FSH levels was also compared. Student’s t-test, paired and unpaired, were performed for different data. 69 patients were studied. 52.17% had tumours 4-6 cm, >6 cm in 47.83%. Tumour was bilateral in 36.23%. Laparoscopic cystectomy by monopolar cauterization was the 55.0% patients, laparotomy required in 10.14% patients. Average pre-operative serum AMH level in <29 yrs patients was 3.06±1.35 ng/ml, 2.38±1.54 postoperatively (p<0.001). For 30-35 yrs, they were 2.30±1.16 ng/ml and 1.39±1.01 ng/ml respectively (p<0.001). No significant difference in AMH was found in unilateral and bilateral cases (p=0.842), significant differences were found in pre- and postcystectomy AMH levels in these groups (p<0.001 for both). Pre and post-surgery FSH differences were very significant, p<0.001. When analysing the effect of different types of surgery we found that coagulation and excision both have negative effect on serum AMH levels, after 3 months (p<0.001). But there is no significant difference postsurgery between these two groups (p=0.0915). Surgery has a negative impact on ovarian reserve in patients with endometrioma, as evident by analysing different metrics and utilising student’s t-test.

Surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma.

To evaluate feasibility and efficacy of surgical approach of laryngofissure combined with epiglottis valley in treating locally-advanced pyriform sinus carcinoma. Clinical data of 216 patients with T3 and T4a pyriform sinus carcinoma, who came from the Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University between January 2013 and December 2019, were retrospectively analyzed. Three different types of surgery were used in these patients. Seventy-three patients were performed by approach of laryngofissure combined with epiglottis valley for partial laryngopharyngectomy (Group I); 75 patients were performed by approach of lateral pharynx for piriform fossa resection (Group II); 68 patients were performed by total laryngopharyngectomy (Group III). All patients were treated with radiotherapy and followed up regularly after operation. Kaplan-Meier regression model was used to analyze the overall survival rate. EAT-10 swallowing scale was utilized to evaluate the postoperative swallowing function, while the rate of tracheal tube extubation and the incidence of postoperative complications in each group were compared. There were 76.7% patients with T3 stage in Group I, 100% patients with T3 stage in Group II, and 64.7% patients with T4a stage in Group III. There was significant difference between them (P<0.01). Clinical stage IV patients in the Group I, Group II, and Group III were 74.0%, 54.7%, and 89.7%, respectively, with significant difference (P<0.01). The 3-year overall survival (OS) rate in Group I, Group II, and Group III were 69.9%, 53.3%, and 58.8%, respectively. Patients in the Group I had a better survival outcome than that in the Group II (P<0.05). The median score of EAT-10 swallowing scale was 12.0 in the Group I, 8.0 in Group II, and 5.0 in Group III, with significant difference (P<0.01). There was no significant difference in the rate of tracheal tube extubation and the incidence of complication among the 3 groups (both P>0.05). Surgical approach of laryngofissure combined with epiglottis valley in the treating locally-advanced piriform sinus carcinoma presents favorable outcome in terms of survival rate and laryngeal function preservation, which deserves to be promoted.

Surgical coaching applied to laparoscopic TME for continuous professional development in rectal surgery: proof of concept.

Coaching is maturing as a strategy for surgeons' continuous professional development in different types of surgery. Laparoscopic total mesorectal excision (LAP TME) is one of the recognized difficult procedures in colorectal surgery. Aim of this trial is to introduce the surgical coaching as a tool for a continuous technical education of LAP TME for cancer in a consultant surgeon carrier. Twelve Italian colorectal surgeons were enrolled as trainees in the AIMS Academy rectal cancer surgical coaching project and attended a face-to-face 90-min surgical coaching on a pre-edited 45-min-long video of a laparoscopic proctectomy according to pre-determined guidelines. At the end of the coaching, all mentors were asked to fill a questionnaire evaluating the trainee's skills. All trainees had to fill a post-coaching questionnaire addressing the appropriateness of the coaching with respect to their actual level. Trainees were more confident in performing the extra-pelvic part of the surgical procedures compared to the intra-pelvic dissection. The most challenging steps according to the trainees were the seminal vesicles identification and the pelvic floor dissection. Mentors found the trainees quite confident in the approach to the vascular structures, lymphadenectomy, stapler utilization and bleeding control. The sharpness and the efficacy of the dissection, the dissection of the surgical planes and the anastomosis fashioning were reported at a lower level of confidence. The higher grade of satisfaction reported by the trainee came from the attention that the mentors demonstrated towards them, from the availability of the mentors to take into consideration the surgical issues raised and from the willingness to apply the suggestions received during their next proctectomies. The surgical coaching applied to LAP TME should be considered as an innovative tool for continuous professional development.

Improvement of Lipid Profile after One-Anastomosis Gastric Bypass Compared to Sleeve Gastrectomy.

Fewer studies compared the improvement of plasma lipid levels after different types of surgery, in particular compared to one-anastomosis gastric bypass (OAGB). The aim of our study was to investigate how laparoscopic sleeve gastrectomy (LSG) and OAGB impact on weight loss and lipid profile 18 months after surgery, in patients with severe obesity. Forty-six patients treated with OAGB were matched to eighty-eight patients submitted to LSG. Weight loss after OAGB (33.2%) was more evident than after LSG (29.6%) (p = 0.024). The difference in the prevalence of dyslipidemia showed a statistically significant reduction only after OAGB (61% versus 22%, p < 0.001). After adjustment for delta body mass index (BMI), age and sex, we demonstrated a statistically significant decrease of the differences between the changes before and after (delta Δ) the two surgery procedures: Δ total cholesterol values (p < 0.001), Δ low density lipoprotein-cholesterol values (p < 0.001) and Δ triglycerides values (p = 0.007). Patients with severe obesity undergoing to OAGB presented a better improvement of lipid plasma values than LSG patients. The reduction of lipid plasma levels was independent of the significant decrease of BMI after surgery, of age and of sex.

Utilizing the Most Accurate Preoperative Risk Calculator.

The most commonly used preoperative assessment tools include the American College of Surgeons National Surgical Quality Improvement Program and the Revised Cardiac Risk Index. These tools seek to predict the risk of an individual experiencing postoperative complications, including but not limited to mortality, myocardial infarction, pneumonia, stroke, venous thromboembolism, and pneumonia. Many published studies have sought to objectively quantify the utility of the preoperative risk calculations by retrospectively compiling data for patients who underwent the same or comparable surgeries to compare actual complications to predicted complications. Therefore, we searched these studies to review the literature to draw more general conclusions and recommend which risk calculator is best for different types of surgeries.

How Large a Study Is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis.

How Large a Study Is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis.

Myasthenia Gravis: Which Type of Surgery Is Best?

In their study “Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis: A Meta-analysis,”1 Dr. Solis-Pazmino and colleagues tried to answer what sounds like a simple question: what type of surgery is best for myasthenia gravis (MG)? Most would agree that the “best” surgery is the one that has the most effect with the fewest complications. Another way of saying this is that the best surgery has the lowest risk with the highest benefit. Nowadays, there are many different types of surgery for MG. As technology has advanced, so have surgical approaches. Modern approaches often use minimally invasive techniques, sometimes with the aid of robots. These delicate surgeries can achieve goals that previously could only be accomplished with more invasive methods. The question asked by Dr. Solis-Pazmino et al. seems simple at first, but the path to finding the answer turns out to be complicated.

English

BACKGROUND There is a wide range of adnexal masses ranging from functional cyst to infection and even malignancy. Epithelial ovarian tumours are the most common benign ovarian lesion. The purpose of this study was to study the pattern of adnexal masses in rural area and plan the preventive steps according to the pattern. METHODS It was a retrospective study of patients who presented with adnexal masses in Bhagat Phool Singh Medical College (Women), Khanpur, Sonepat, Haryana, India over a period of 5.5 years from September 2012 to August 2018. The file records of the patients who underwent surgery for adnexal masse were evaluated to identify the risk factors, presenting complaints, examination findings, serological markers and radiological findings. The histopathological reports were reviewed. The cases excluded were ectopic pregnancies. Frequency distribution tables were used and data was analyzed using percentages. RESULTS Out of total 180 adnexal masses, 167 (92.77 %) cases were of ovarian origin. Out of these, 150 (83.33 %) cases were benign and 17 (9.44 %) were malignant. Among the benign lesions, serous cystadenoma was the most common lesion counting for 54 cases i.e., 30 %. In our study, most common symptom was vague abdominal pain- 63.88 %. Maximum adnexal masses were in the age group of 41 - 50 years i.e., 53 (29.44 %). Different types of surgeries were done. Maximum were bilateral oophorectomies with transabdominal hysterctomy 88 (48.88 %). CONCLUSIONS By proper education about personal and perineal hygiene, use of contraceptives, we can at least prevent some sexually transmitted diseases causing pelvic inflammatory disease (PID) and adnexal masses. KEYWORDS Adnexal Mass, Benign, Malignant, Serous Cystadenoma

Microinvasive Glaucoma Surgery: An Evidence-Based Review

ABSTRACT Purpose: Interest in micro-invasive glaucoma surgery (MIGS) has exploded over the last 8 years with an increase in MIGS procedures of at least 400% in the United States, according to Medicare data. MIGS is an umbrella term that can cover many different types of surgeries. This review focuses on peer-reviewed evidence for Trabectome®, iStent inject ®, Kahook Dual Blade®, XEN® Gel Stent, and Hydrus®. Methods: We present key recent studies evaluating the efficacy and safety of MIGS in various types of glaucoma patients with different stages of disease. Conclusion: We conclude that MIGS is generally safe and efficacious, although only some MIGS have been studied through randomized clinical trials. When comparing and contrasting the different MIGS procedures, large prospective studies are not yet the norm. High-quality large prospective studies involving MIGS will be an important next step as ophthalmologists decide how to incorporate MIGS into their surgical armamentarium.

Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

Corneal Endothelial Changes in Patients With Primary Congenital Glaucoma.

Specular microscopic parameters were found to be decreased in patients with primary congenital glaucoma (PCG). Patients with PCG and Haab striae had lower endothelial cell density (ECD) and central corneal thickness (CCT) than those without Haab striae did. The type of surgery (viscogoniotomy, viscotrabeculotomy, or combined viscotrabeculotomy and trabeculectomy) did not affect specular microscopic parameters. The purpose of this study was to compare specular microscopic parameters such as corneal ECD, coefficient of variation (CV), hexagonal cell percentage (HEX), and CCT between patients with PCG and healthy controls; to determine the predictive ability of Haab striae for endothelial cell changes PCG by comparing patients with and without Haab striae; and to investigate if the type of surgery used to treat glaucoma (viscogoniotomy, viscotrabeculotomy, or combined viscotrabeculotomy and trabeculectomy) affects specular microscopic parameters. A cross-sectional specular microscopic analysis of patients with PCG and healthy controls was performed. One hundred eyes of 62 patients with PCG with and without Haab striae and 101 eyes of 101 healthy controls were enrolled in this study. Specular microscopic parameters, including ECD, HEX, CV, and CCT, of all subjects were evaluated. Patients with PCG showed significantly lower ECD and CCT than healthy controls did. Those with Haab striae had lower ECD and CCT but no differences in age, HEX, and CV compared with those without Haab striae. ECD, CV, HEX, or CCT did not significantly differ among patients treated with the 3 different types of surgery. Prolonged exposure to elevated intraocular pressure during prenatal and/or early postnatal life results in structural changes in immature infant corneas. Specular microscopic parameters differed significantly between healthy controls and patients with PCG. The type of surgery had no effect on these parameters. Among patients with PCG, those with Haab striae had isolated corneal endothelial cell loss without morphologic changes within the endothelium.