Different Types Of Surgery Research Articles

Comparison of laparoscopic and open radical gastrectomy for gastric cancer patients with GLIM-defined malnutrition.

Malnutrition is common in the patients with gastric cancer. Radical gastrectomy remained the primary strategy of curable treatment for gastric cancer. This study is performed to explore the effect of laparoscopic radical gastrectomy on clinical outcomes in gastric cancer patients with malnutrition. Gastric cancer patients with GLIM-defined malnutrition between 2014 and 2019at our center were enrolled. The patients were divided into two groups according to the different type of surgery. Propensity score match analysis was used to balance the clinicopathologic characteristics of two groups. Postoperative outcomes and survival were compared. Multivariate analysis was used to independent risk factors of complication, overall survival (OS), and disease-free survival (DFS). Compared with patients underwent open radical gastrectomy, patients who underwent laparoscopic radical gastrectomy had lower rate of total, surgical and severe complications. They also had shorter postoperative hospital stay with better OS and DFS. Hypoalbuminemia (P=0.003) was the independent risk factor of complications. Old age (≥75, P=0.035) and TNM stage (III: P<0.001, II: P=0.015) were the independent risk factors of OS. Combined resection (P=0.003) and TNM stage (III: P<0.001, II: P=0.001) posed independent risk factors of lacking DFS. Laparoscopic surgery proved to be the independent protective factor of complications (P=0.014), OS (P<0.001) and DFS (P<0.001). Laparoscopic radical gastrectomy was relative safe and showed favorable outcomes in malnourished gastric cancer patients.

Perioperative Respiratory Outcome of Patients with Eosinophilia: A Cohort Study in a Tertiary Care Hospital.

A respiratory adverse event is one of the main causes of critical events in the perioperative period. Perioperative distress symptoms like cough and stridor have been reported to occur in patients with hyperreactive airways. This study was conducted to determine the relationship between blood eosinophil count and perioperative adverse respiratory events among different age groups of patients who require general anesthesia for different types of surgeries. A cohort study was conducted on 197 patients of either gender, aged 3 years and above, belonging to ASA classes I-II, who were scheduled to undergo surgery requiring general anesthesia and intubation. Patients were stratified according to absolute eosinophil count into two groups: Group A (AEC 0 to 499/mm3) and Group B (AEC 500 to 1000/mm3). Patients were monitored for 24 hours in the perioperative period for adverse respiratory events such as bronchospasm, laryngospasm, a fall in SPO2 < 95%, and cough and stridor. A total of 197 patients were evaluated, with a median age of 37 ± 14.4 years. The percentage range of adverse respiratory events across different age groups was 35% in adults to 60% in children. Major complications noted were a fall in SPO2 < 95% (62.5%) and cough (27.7%) as per CTCAE v5.0 (November 27, 2017). The Naranjo score of adverse respiratory events was categorized as possible with mild level 1 severity. Adverse respiratory events were managed with humidified oxygen, antitussives, and bronchodilators. Eosinophilia is seen in one-third of the patients undergoing surgical interventions. Patients with a blood eosinophil count of ≥400/mm3 had an increased risk of exacerbations of respiratory adverse events in the perioperative period.

Predictors of surgery choices in women with early-stage breast cancer in China: a retrospective study

BackgroundThe breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer.MethodsThis retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice.ResultsA total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer.ConclusionsIn China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.

Role of Metabolic Surgery in Polycystic Ovarian Disease with Obesity in the Asian Population: A Systematic Narrative Literature Review

Abstract Polycystic ovarian syndrome is becoming more prevalent (up to 13%) among young women of reproductive age with obesity. Lifestyle modifications remain the first line of management of obesity in these individuals. Bariatric and metabolic surgery (BMS) has a role in achieving significant and sustained weight loss in cases where lifestyle modifications alone are not effective. A detailed systematic narrative literature review was undertaken to understand the role of BMS in this subset of individuals to help recommend management strategies in women with polycystic ovarian syndrome, obesity, and infertility among the Asian population. BMS has been documented to correct menstrual irregularities (from 81% to 15%, odds ratio = 0.03, 95% confidence interval: 0.01–0.08), hirsutism from 71% to 38% (odds ratio = 0.21, 95% confidence interval: 0.06–0.74), and endocrine abnormalities associated with polycystic ovarian syndrome. Improvement in infertility (high incidence of nearly 58%) was noted with normalization of the body mass index (BMI) postsurgery in some studies. Larger sample size studies with a longer follow-up are required to enable the development of guidelines on the role of BMS in the improvement of infertility in patients with polycystic ovarian syndrome. The superiority of one type of technique of BMS has not been demonstrated for improving the fertility rates (P = 0.9) among the different types of surgical procedures and pregnancy rates. Different regions of the world will need different BMI cutoffs while managing the endocrine abnormalities, menstrual irregularities, and associated infertility of women with polycystic ovarian syndrome and obesity. This systematic narrative literature review is an attempt to study the relevant literature in this field with a special focus on the Asian population.

Differences in postoperative satisfaction between orthopedic and cosmetic patients

Undergoing any surgery can be impactful on a patient’s emotional state and satisfaction. Surgeries can range from elective to emergency with the goal to improve functional or aesthetic outcomes. Specific types of surgeries may differentially affect a patient’s contentment with outcomes. Given this significant and variable impact, it is valuable to investigate how different types of surgeries can impact a patient in different ways in hopes to improve individualized patient support. The current study aims to investigate differences in psychological outcomes from patients who have undergone either cosmetic surgery (e.g., liposuction, breast augmentation, breast reduction, tummy tuck) or orthopedic surgery (e.g., hip replacement, knee replacement, rotator cuff surgery). Data was retrospectively collected through self-report surveys completed by adult patients (aged 18 to 50) who underwent first-time surgery. Survey items requested participants to rank their level of satisfaction at different time points before and after surgery. We hypothesized that patients who had cosmetic surgery would be more satisfied after surgery than patients who had orthopedic surgery. Results of this study revealed cosmetic patients temporarily had more satisfaction than orthopedic patients 1-2 weeks after surgery. These findings may demonstrate a better understanding of patients’ satisfaction with outcomes in varying types of surgeries. In this specific study, we might draw the inference that orthopedic patients were less satisfied because their mobility was compromised immediately post-operatively and they required time to recover. We may also infer that cosmetic patients were more satisfied shortly after surgery with higher expectations for their altered appearance.

Influence and Role of Vitamin D on Dental Implants

Dental implants are one of the methods for replacing missing teeth and their use has become an important part of dentistry. Dental implants have many advantages over traditional fixed partial dentures, including a high success rate of over 97% for 10 years among certain others. Vitamin D is involved in the calcium and phosphate metabolism of bone tissue in the body and in the maxillofacial region. This information can help dentists reduce the risk of complications after different types of surgery, like dental implant surgery and bone grafting. Due to its involvement in bone metabolic processes and regulation of the immune system, vitamin D is currently of particular interest to dentists performing implant procedures. It is believed that the correct concentration of this prohormone is positively correlated with the process of osseointegration. Numerous studies show that vitamin D is potentially important for the process of postoperative tissue repair, as well as the integration of the implant with bone tissue and bone homeostasis around the implant after it is loaded with a prosthetic crown. Furthermore, adequate serum levels of vitamin D may improve peri-implant bone healing. To date, only a few studies have investigated the possible association between serum vitamin D levels and early dental implant failure hence further clinical research is need of time to provide evidence -based results for the role of vitamin D in dental implants. The purpose of this research is to review the available information about influence and role of vitamin D on dental implants.

Association between Fecal Microbiota, SCFA, Gut Integrity Markers and Depressive Symptoms in Patients Treated in the Past with Bariatric Surgery-The Cross-Sectional Study.

(1) Background: Depressive symptoms often appear after surgical treatment. (2) Methods: We involved 41 adults who underwent bariatric surgery a minimum of 6 months before the study and had the Beck scale ≥12. We analysed patients' mental state, gut barrier markers, faecal short chain fatty acids, and microbiota. (3) Results: Gut microbiota composition differed significantly among patients undergoing two different types of surgery (F = 1.64, p = 0.00002). Additionally, we discovered an association between short chain fatty acids and the Beck scale (F = 1.22, p = 0.058). The rearrangement of bacterial metabolites may be due to the patients' use of increased dietary protein, with insufficient intake of products containing vegetable fiber (Diet Quality Index (DQI-I )adequacy 22.55 (±3.46) points). (4) Conclusions: Bariatric surgery affects the gut microbiota, which may play an important role in the development of depressive and gastrointestinal symptoms in patients after bariatric surgery. Low fiber consumption and increased levels of faecal isobutyric acid may lead to intestinal inflammation. There is a need for further research on this topic including a larger sample size.

537. First Week Post-Operative C-Reactive Protein Kinetics Show Different Patterns of Association with Infection Depending on the Type of Surgery

Abstract Background C-reactive protein (CRP) is a nonspecific marker of inflammation and due to surgery alone CRP levels are increased post-operatively. Although multiple studies investigated the potential of post-operative CRP levels to predict post-operative infection, its discriminative capacity remained unclear. We aimed to describe the kinetics of CRP for post-operative patients with- and without a post-operative infection for different types of surgery in the first seven post-operative days. Methods We conducted a single center cohort study in adult patients undergoing surgery between 2011 and 2021 with the use of whole digital case file extraction (big data). All patients that had either an infectious complication registered, non-prophylactic antibiotics prescribed and/or an infection related surgical re-intervention within 7 days after having undergone surgery, were labelled as having an infection. We analyzed the CRP kinetics in the first seven post-operative days for all these patients. Results A total of 39.985 individual patients were included of which 12.002 patients had at least one CRP measurement and 4.014 patients had an infection in the first seven post-operative days. CRP was measured in 66% of the patients with an infection and in 26% of the patients without an infection. In all patients CRP increased during the first two post-operative days regardless of infection status (Figure 1). In cardiothoracic, orthopedic, ear-nose-throat, general and urological surgery CRP decreased after day 2 or 3 in all patients but the absolute CRP value remained higher in the following days in patients with an infection compared to patients without an infection. In gynecological and oral surgery CRP decreased on day 3 in patients without an infection but not before day 4 in patients with an infection. CRP was not discriminative in neurosurgical or plastic surgery patients (Figure 2). CRP kinetics in the first seven post-operative days for patients with- and without an infection CRP kinetics for different subspecialties in the first seven post-operative days CTS = cardiothoracic surgery; ENT = ear-nose-throat surgery; GEN = general surgery; GYN = gynecological surgery; NEUR = neurosurgery; ORAL = oral surgery; ORT = orthopedic surgery; PLA = plastic surgery; URO = urological surgery. Conclusion In the first 2 post-operative days CRP increases in both patients with- and without an infection which is probably due to the surgical procedure itself. After the second post-operative day differences in CRP kinetics develop between patients with- and without an infection, but how they differ depends, among other factors, on the type of surgery. Disclosures Siri L. van der meijden, MSc, Healthplus.ai: Employee Bart F. Geerts, MD. PhD., Healthplus.ai: Board Member.

The Anesthesia Techniques for Reductions Intraoperative and Postoperative Complication and Post-Operative Morbidity and Mortality of Stroke Patients

Background: Stroke during surgery is the most dreaded complication for both the patient and the medical team. Stroke risk during surgery reportedly varies across procedures. In minor, non-neurologic, and non-cardiac surgeries, its occurrence is typically low. Objective: In this study our main objective is to evaluate anesthesia techniques for reductions intraoperative and postoperative complication and post-operative morbidity and mortality of stroke patients in ICU. Method: This Retrospective study was carried out at the Department of surgery, Khulna Medical College Hospital, Khulna from January 2020 to January 2021 where 100 patients who underwent different types of surgery were randomized to receive thoracic epidural analgesia along with general anaesthesia in Group-A (50 patients) and only GA in Group-B (50 patients) were included the study. Result: During the study, most of the patients belong to 41-50 years age group for both Group A (48%) and group B (42%). Most of the patients in group A faced cardiac surgery, 50% and in group B most of the patients faced neurologic surgery before stroke, 50%. In group A 80% patients had ischemic and 20% had hemorrhagic. Whereas in group B 85% patients had ischemic and 15% had hemorrhagic. Plus, in group A total 90% patients stay in hospital 6-10 days where as group B it was 15%. Moreover, in group A mortality rate was 20% where as in group B it was 25%. Conclusion: Our findings suggest that combining TEA and GA during surgery reduces the risk of stroke for patients to a similar extent as GA alone. Even more research is required for a more favorable result.

Dexamethasone as analgesic in different types of gynecologic surgery – A literature review

Background: Dexamethasone is a glucocorticoid and is widely used for postoperative nausea and vomiting (PONV). Recent studies and subsequent guidelines also suggest a role as an analgesic. Dexamethasone as an analgesic has been studied with varying degrees of success in different types of surgery with intravenous doses ranging from 4 mg to 80 mg. The procedure specific postoperative pain management (PROSPECT) guidelines for elective cesarean sections, laparoscopic hysterectomy and oncologic breast surgery all recommend the use of dexamethasone as an analgesic in a multimodal pain regimen, however a particular dose is not mentioned. Objective: To provide a literature review of the use of dexamethasone as an analgesic and at what dosage it has been studied in elective cesarean sections, gynecological laparoscopy and oncologic breast surgery. Methods: The Embase, PubMed, and Cochrane databases were searched for randomized controlled trials published between 2000 and 2021. Results: A total of thirty-four articles were found. Fourteen about elective cesarean section, Thirteen concerning gynecologic laparoscopy and seven regarding oncologic breast surgery. Literature review demonstrated that during elective cesarean section the intravenous (IV) doses ranged from 4 mg to 16 mg. The most investigated IV dose was 8 mg, but overall studies showed conflicting results concerning pain scores and analgesic use. In gynecologic laparoscopy the IV dose ranged from 4 mg to 15mg and again 8 mg was the most frequently studied dose. The IV dose of dexamethasone in oncologic breast surgery ranged from 8 mg to 24 mg. Also in these studies the results were conflicting. In addition, dexamethasone was used as an adjunct to locoregional blocks (perineural use): the transversus abdominis block (TAP) in cesarean section, the serratus anterior plane block (SAP) and the paravertebral block (PVB) in oncologic breast surgery. Conclusion: This literature review provides an overview of the use of dexamethasone in elective cesarean section, gynecologic laparoscopic surgery and oncological breast surgery. Three routes of administration were examined: intravenous, perineural and intraperitoneal. IV 8 mg dexamethasone was the most studied dosage but there were mixed results. Based on this literature review we cannot draw any conclusions regarding the analgesic dose. Further research, with more qualitative RCT’s and systematic reviews with meta-analysis are needed.

PREOPERATIVE RISK ASSESSMENT IN CARDIAC SURGERY. EUROSCORE I AND EUROSCORE II IN A MODERN COHORT.

<h3>Introduction</h3> EuroSCORE I was used to predicting mortality among patients undergoing cardiac surgery. Nonetheless, it overestimated the risk. Since its introduction in 2011, the EuroSCORE II has been used instead of Euroscore I. Nowadays EuroSCORE II is a worldwide useful tool to assess the preoperatory risk of mortality in cardiac surgery. <h3>Objective</h3> This paper aims to assess the EuroSCORE II and EuroSCORE I in a contemporary cardiac surgery cohort in Spain. Moreover, we wanted to evaluate its performance in different types of surgeries. <h3>Methods</h3> The original logistic EuroSCORE was compared to EuroSCORE II and with the observed mortality in our center. We studied patients that underwent surgery from 2017 to 2021. Analysis was performed amongst patients that underwent: coronary artery bypass grafts alone (CABG) n=406, aortic valve replacement alone (AVR) n=489 (we excluded patients undergoing transcatheter aortic valve implantation) and the last group of patients were those undergoing a complex cardiac surgery (2 or more procedures) n=455. Total of patients n=1350 <h3>Results</h3> Logistic EuroSCORE of our overall population was 11,69 % whereas EuroSCORE II was 4,05 %. Our observed mortality was 3,92%. For the population of CABG, Logistic EuroSCORE was 8,91 %, EuroSCORE II was 2,5% and the mortality was 2,21%. In the group of AVR Logistic EuroSCORE was 12,05%, EuroSCORE II was 3,2% and the observed mortality was 2,04%. Finally, in those patients that underwent a complex cardiac surgery, their Logistic EuroSCORE was 14,53%, EuroSCORE II was 6,34% and the mortality in this group was 7,47%. <h3>Conclusion</h3> EuroSCORE II is more accurate than logistic EuroSCORE for the assessment of preoperatory risk in patients undergoing cardiac surgery. Its use for AVR isolation may be controversial as it overestimates the risk.

Effectiveness and safety of path-based analgesic regimens designed by clinical pharmacists based on the type of biliary and pancreatic surgery.

As the incidence of postoperative pain in patients with biliary and pancreatic diseases has gradually increased, how to control postoperative pain has received increasing research attention. By reading pain management guidelines and multidisciplinary communication and cooperation, clinical pharmacists designed multi-mode analgesia regimens based on surgical types, in order to provide strong evidence for the effectiveness and safety of postoperative analgesia regimens and better serve patients. Data from biliary or pancreatic surgery performed at Nanjing Drum Tower Hospital from 2019 to 2021 were collected. Take October 2020 as the time point to compare the outcomes before and after the implementation of the path-based postoperative analgesic regimens. The primary outcomes were NRS pain scores, sleep quality, and incidence of adverse reactions. Length of stay was a secondary outcome. A total of 268 and 239 patients were enrolled in the study and control groups, respectively. Four path-based postoperative analgesic management regimens significantly reduced patients' static and dynamic NRS scores in the 24 h (p < 0.05). The patients' sleep quality were better than controls (p > 0.05). The incidence of adverse reactions and the length of stay in the study group were numerically lower than controls. Moderate analysis indicated that four analgesia regimens are more precise and better meet actual clinical needs. Effective and safe postoperative pain management is particularly important for clinical purposes. Path-based postoperative analgesia regimens based on different types of surgery overcome the disadvantages of overly broad and generalized traditional guidelines, which play an important role in providing personalized and precise clinical services. Further, study findings provide evidence that four path-based analgesic regimens can reduce postoperative pain and reduce the length of hospital stay, which may provide a better direction for clinical postoperative pain management.

Paget's disease of the breast: Our 20 years' experience.

Paget's disease (PD) represents 1%-3% of all breast cancers and mostly occurs in postmenopausal women. Multiple studies have confirmed that breast-conserving surgery (BCS) followed by radiotherapy is a safe option for patients with in situ or invasive PD, ensuring local control and survival rates similar to those achieved with mastectomy. We retrospectively analyzed 115 patients affected by PD treated in our institution between January 2000 and May 2021. Median age at diagnosis was 60 years and median follow-up was 82 months; 69 patients were treated with BCS and 46 were treated with modified radical mastectomy or skin-sparing mastectomy. At histological examination, 59 patients (59/115, 51.0%) had an underlying invasive carcinoma; in 11 patients (11/115, 9.0%), only PD was found. In 45 patients (45/115, 40.0%), only noninvasive cancer was found. Nine patients (9/115, 7.8%) developed a local recurrence, 7 patients (7/115, 6.0%) are alive with distant metastasis, and 10 patients (10/115, 8.6%) died. In our series, no statistically significant differences were shown between PD alone, PD associated with in situ cancer, and PD with invasive cancer, regardless of the surgical procedure. BCS followed by radiotherapy appears to be an effective and safe option for patients with PD. PD is a rare form of breast cancer and, in half of the cases, is associated with an invasive carcinoma. Separating our sample into three subgroups based on tumor histology, there were no significant differences in terms of LC, DFS, and OS rate in patients treated with different types of surgery. This study presents some limitations due to its retrospective nature and being confined to a single institution.

Dynamic changes in quality of life, psychological status, and body image in women who underwent a mastectomy as compared with breast reconstruction: an 8-year follow up.

Surgical decisions and methods of surgery highly influence long term QoL for breast cancer (BC) survivors. This study is aimed towards an exploration of the dynamic changes in quality of life (QoL), anxiety/depression status, and body image (BI) among women with BC who received a mastectomy compared with those receiving breast reconstruction (BR) within an 8-year follow-up period. Women with major BC surgeries were invited to complete the World Health Organization Quality of Life-Brief (WHOQOL-BREF), the European quality of life five dimensions questionnaire (EQ-5D), and a body image scale within 8years of surgery. Kernel smoothing methods were applied to describe dynamic changes in QoL, anxiety/depression, and BI at different time points. Linear mixed effects models were constructed to identify the interaction between time, different types of surgery, and the determinants of QoL in these patients. After 1:10 propensity score matching, a total of 741 women who had undergone a BR and mastectomy were included. The BR group exhibiteda high WHOQOL QoL score one to five years after surgery with some fluctuations. The mastectomy group had comparatively stable QoL scores on WHOQOL items and were less depressed/anxious. The BR group generally showed fluctuating, higher BI scores two years after surgery, but they exhibited more anxiety/depression during follow up for 8years. Medical comorbidities, the status of anxiety/depression, and BI were the major factors influencing all domains and items of the WHOQOL BREF among women with BC. The mastectomy group showed a decreased trend toward depression in patients with BC. The BR group showed a significant improvement in QoL in the first 5years with massive fluctuations. These findings should be considered and discussed in patient participatory decision-making and promotion of QoL for breast cancer survivors.

Complicaciones abdominales posquirúrgicas

Complications after abdominal surgery are often seen in emergency departments. Many postoperative complications (e.g., infections, abscesses, hematomas, and active bleeding) are common to all types of surgery; others are specific to different types of surgery. Computed tomography (CT) is the technique normally used to diagnose postoperative complications.This article reviews the changes that occur after some of the most common abdominal interventions that can be mistaken for pathological processes, the findings that can be considered normal after surgical intervention, and the most common early complications. It also describes the optimal protocols for CT studies depending on the different types of complications that are suspected.

Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study

BackgroundSeveral studies on various bariatric surgeries involving patients with type 2 diabetes mellitus (T2DM) showed an overall rate of remission of hyperglycemia. However, there is little known about predictive factors on remission after different types of surgeries. The aim of this study was to identify the T2DM remission rate and to determine the effects of preoperative factors characteristics of remission of type 2 diabetes in Iran.MethodsWe conducted a retrospective analysis of 1351 patients with T2DM operated by three different types of surgeries (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and One Anastomosis Gastric Bypass (OAGB)). Diabetes remission was defined according to the American Diabetes Association (ADA) criteria. Binary logistic regression analyses were employed.ResultsA total of 1351 patients, 675 patients (50.0%) undergoing OAGB, 475 (35.2%) RYGB, and 201 (14.9%) SG. 80.6%, 84.2% of OAGB, 81.7%, 82.6% of RYGB, and 77.1%, 81.5% of SG participants were in T2DM remission after 1 and 3 years, respectively. 1- and 3-year remission were associated with preoperative age, duration of T2DM, FBS and HbA1c, BMI, insulin therapy, and a family history of obesity (p < 0.05).ConclusionThe remission of T2DM after RYGB, SG, and OAGB surgery is dependent on various preoperative factors. Patients with younger age, shorter duration of T2DM, lower preoperative HbA1c and FBS, higher BMI, who were not on insulin therapy, and not having a family history of obesity were the best candidates to achieve a prolonged diabetes remission.

Dissection of Tubercular Neck Node for Diagnosis as well as Therapy- A Study of 150 Cases in CMH Dhaka

Introduction: Tubercular lymphadenitis nowadays is the commonest extra pulmonary manifestation of tuberculosis in Bangladesh. Sometimes it causes diagnostic and therapeutic challenge for the clinicians. Occasionally Clinical, laboratory findings and fine needle aspiration cytology (FNAC) is not optimum that creates diagnostic and therapeutic dilemma. FNAC is often inconclusive. Sometimes therapy failed cases and atypical tuberculosis require open biopsy and neck dissection. Objective: To see the effectiveness of lymph node dissection &amp; biopsy for diagnostic purpose and efficacy of the operation in suspected Multi-drug resistant tuberculosis (MDR-TB) for treatment failure due to any reason. Material and Methods: This cross sectional observational study was conducted during the time period of 01st Jan 2014 to 1st Jan 2020 in ENT &amp; Head-Neck Surgery &amp; Pulmonology department, Combined Military Hospital Dhaka on 150 patients who have undergone surgical neck dissection. Results: In this study total number of patients were 216. FNAC was done for all of them and found nonspecific lymphadenitis for 41 cases, lymphoma for 12 cases, sarcoidosis for 08 cases and kikuchi disease for 05 cases. 150 patients were found inconconclusive in FNAC. Inclusion criteria are followings, 1. FNAC is inconclusive &amp; negative 2. Surgery was not done before. Among 150 patients different types of surgery was done like enblock resection, selective neck dissection and modified neck dissection. Histopathologically 06 cases found nonspecific lymphadenitis, 03 cases found lymphoma and 01 case found sarcoid granuloma. 150 cases were found histopathologically tubercular lymphadenitis. They show positive findings in biopsy, caseation necrosis- (100%), C/S +, among the Gene Xpert tests- Gene X-pert (Rif sensitive 83.33%, Rif resistant 16.66%). After completion of anti-tubercular therapy (ATT) (CAT-I HRZE) for total 150 patients, 125 patients were cured and 25 patients were not cured (treatment failure). Out of 25 patients 10 developed multiple cold abscess, 08 developed discharging sinus and 07 had relapse during follow up. 2nd Surgical interventions were done in total 25 patients, 10 TB abscess during ATT (CAT-1 HRZE), 8 discharging sinus and 7 relapse patients along with ATT (CAT-2 SHRZE) and all these patients had no relapse or treatment failure during further follow up. Conclusion: Tuberculous lymphadenitis is best treated with antitubercular medication and in addition surgical neck dissection is more useful in selected cases. So role of surgery is most useful for diagnostic accuracy as well as adjunct to the treatment avoiding prolongation of ATT and noxious side effects of drugs and also to prevent the formation of abscess and sinus. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 86-89

Some features of the pathogenetic mechanisms of the development of acute adhesive small bowel obstruction

Aim . To study the pathogenetic mechanisms of the development of acute adhesive small bowel obstruction. Material and methods . An analysis is given of the results of a comprehensive examination of 50 patients with acute adhesive small bowel obstruction. In 46 (92%) observations out of 50 (100%) patients, the causes of acute adhesive small bowel obstruction were various pathologies of the abdominal cavity organs, which had a history of diff erent types of surgery and volume of surgical interventions, and in 4 (8%) cases it was primary, without carrying out surgical interventions. Results . The results of the study showed a signifi cant decrease in the level of serotonin in biopsies of the mucous membrane of the small intestine and in the blood serum with the progression of oxidative stress and cytokine activity in patients with acute adhesive small bowel obstruction, who had a history of various surgical interventions on the abdominal and pelvic organs, and there were also infl ammatory processes in the small intestine. This leads to disruption of the motor function of the small intestine, the development of intestinal paresis. Depending on the extent of the lesion and the occurrence of pathomorphological changes in the walls of the small intestine, single or multiple viscero- visceral and viscero- parietal adhesions are subsequently formed with the development of acute adhesive small bowel obstruction. Conclusion . Thus, in the pathogenesis of acute adhesive small bowel obstruction, the leading place is given to a decrease in the number and qualitative composition of EC-cells of the small intestine mucosa producing serotonin due to oxidative stress and cytokine activity.

Implementation of an enhanced recovery after surgery program including a patient school: Impact on quality of life results

IntroductionEnhanced Recovery After Surgery (ERAS) protocols and educational programmes have been shown to accelerate orthopaedic surgery recovery with fewer complications, and improve patient-reported outcomes (PROs) for different types of surgery. The objective was to evaluate the impact of an ERAS programme including a patient school on health outcomes and PROs for Total Knee Replacement (TKR) surgery. Material and methodsA multidisciplinary group created the programme and the patient school (preoperative consultations where the patients’ surgical processes are explained and are also given instructions for an appropriate perioperative care management). An observational, prospective study was conducted on all patients operated for TKR from March 2021 to March 2022. Main health outcomes were: hospital stay length, surgical complications and surgery cancellations due to a wrong preoperative medication management. PROs evaluated were: patient satisfaction with pain management, the school, and quality of life before and after surgery (EQ-5D). ResultsOne hundred thirty-three patients were included. Median hospital stay length was 3 days (IQR 3-5). Rate of surgical complications was 25.6%. No surgery was cancelled. Patient satisfaction rates with pain management and with the school were 8.10/10 and 9.89/10, respectively. Concerning quality of life, mean improvement in mobility and knee pain after the surgery was 0.66 (p < 0.05) and 0.84 (p < 0.05), respectively. ConclusionsThe ERAS programme including a patient school was highly successful with a fast recovery, a short hospital stay length, no surgery cancellations, and improved PROs.

COMPARING QUALITY OF LIFE IN BREAST CANCER PATIENTS AFTER MODIFIED RADICAL MASTECTOMY VERSUS BREAST-CONSERVING SURGERY AT GOVERNMENT CANCER HOSPITAL, AURANGABAD

Background: Breast Cancer is the most frequently seen cancer among women. Different types of surgeries for Breast cancer have a different impact on the quality of life of the patients. The aim of the study is to evaluate the cosmetic effect and impact of surgery type on quality of life in Breast cancer patients. Methods: 30 patients of Breast Conservative Surgery (BCS) and 30 patients of Modified Radical Mastectomy (MRM) aged between 25 to 85 years were included in this study. The complete demographic data, tumor characteristics and treatment modalities used were recorded. Validated Turkish version of EORTC QLQ 30 (Version 3) and EORTC QLQ BR45 questionnaires were used for all patients to assess the quality of life and Harvards scale was used for Breast cosmesis grading. Statistical analysis was done to compare BCS and MRM data which was collected Results: When identical parameters were compared in both arms of BCS and MRM taking into consideration the factors like general wellbeing, physical role, cognitive, sexual, psychological, social functions BCS has a favorable outcome on the quality of life of the Breast Cancer patients. The results are statistically significant as well. Conclusions:Quality of life of Breast cancer patients depends on type of surgery done. So in the decision making process, active patient participation is sought as per quality of life should be taken into consideration and treatment planning should be done accordingly.