Drain Removal Time Research Articles

Checking vesicourethral anastomosis for urinary extravasation during radical prostatectomy: is it still necessary in the robotic era? A prospective, randomized case-control study

PurposeThis study aims to evaluate the role of intraoperative control of the watertightness of vesicourethral anastomosis extravasation control (VUAEC) in predicting vesicourethral anastomosis (VUA) healing and early postoperative outcomes in patients undergoing robot-assisted radical prostatectomy (RARP).Methods100 patients who underwent RARP between October 2020 and May 2023 were consecutively included in the study. Preoperatively, the patients were randomized to undergo VUAEC (Group-A) or not (Group-B). Patients in Group-A were evaluated in 2 subgroups: those with no extravasation observed during VUAEC (Group-A1; n = 31 (62%)) and those with extravasation (Group-A2; n = 19 (38%)). On the 8th post-operative day, a gravity cystogram (GC) was performed on all patients to assess VUA healing.ResultsThere was no statistically significant difference between the groups in terms of clinical features, drain removal time, length of hospital stay, extravasation on GC, catheter removal time and postoperative complications (p > 0.05, for each). There was also no statistically significant difference between the subgroups in terms of drain removal time, length of hospital stays, catheter removal time (p > 0.05, for each). In Group-A2, urinary extravasation on GC was found in a greater percentage, but the difference remained statistically insignificant (p = 0.082).ConclusionsPerforming intraoperative VUAEC did not have a significant role in the prediction of VUA healing and early postoperative outcomes in patients undergoing RARP. The current study did not identify a substantial clinical benefit of routine intraoperative VUAEC.

Effect of peritoneal drainage on the prognosis following appendectomy in pediatric patients with appendicitis: a retrospective study based on appendicitis grade.

This study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16years old) following appendectomy based on the grade of appendicitis. In this retrospective study, we analyzed pediatric patients (≤ 16years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I-V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30days after surgery. A total of 385 pediatric patients with appendicitis were included in the study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1-12] vs 2.74 [1-15], P = 0.049); this difference was also evident among grade I patients (2.80 [1-6] vs 2.47 [1-9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4-5] vs 8.33 [5-15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4-13] vs 4.75 [4-5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH. The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH.

Suction drain usage has no benefit following revision total hip and knee arthroplasty.

The use of drains after primary total joint arthroplasty (TJA) has shown little benefit. Few studies have investigated drain usage after revision TJA. The purpose of this study was to determine whether utilizing suction drains is beneficial for patients undergoing revision arthroplasty. We performed a comprehensive literature review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from the PubMed, Embase, Web of Science, and Cochrane Library. Inclusion criteria of this review were all original articles written in English investigating the efficacy and safety of closed suction drainage in revision TKA or THA, reporting at least one of the following outcome measures: (1) estimated blood loss (EBL), (2) perioperative hemoglobin change, (3) needs for transfusion, (4) postoperative infection, and (5) wound complications. Articles were excluded if they are not available in English or they included case reports, systematic reviews, comments, editorials, surveys, or animal studies prior to July 22, 2023. A total of six studies met inclusion criteria. In total, 655 patients had a drain while 1765 patients did not have a drain after revision total hip or knee arthroplasty. Primary outcomes included for meta-analysis included estimated blood loss (EBL), postoperative hemoglobin, need for transfusion. Other data extracted includes postoperative infections, and wound complications. Six studies met the inclusion criteria. In total, 655 patients had drains, while 1765 patients did not after revision total hip or knee arthroplasty. The average age of the patients was 66.1+/- 3.4 years, and the average BMI was 30.3 +/-0.8. There was no difference in postoperative infections (p = 0.14), wound complications (p = 0.621) or need for transfusion (p = 0.521) between the two groups. There was also no difference in EBL (Hedges' g CI[-3.52, 2.77]) or postoperative Hb (Hedges' g CI[-1.65, 2.41]) between patients with and without drains. Our results do not show any benefit from drain placement after revision total hip or knee arthroplasty. With the increased cost, time and need for drain removal, this is likely an unnecessary intervention. Level III, systematic review and meta-analysis.

Intraoperative Hypertonic Saline Irrigation Preventing Seroma Formation in the Treatment of Axillary Bromhidrosis.

Subcutaneous seroma formation (SF) is commonly seen after axillary bromhidrosis surgeries and its treatment can be challenging and long. Current prevention methods are not consistent, and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of intraoperative hypertonic saline irrigation (IHSI) to axillary bromhidrosis subcutaneous dead space, which prevents postoperative SF and enables early drain removal due to reduced secretions. From 2015 to 2022, we performed the intraoperative irrigation of the cavity through normal saline in 100 patients with primary axillary bromhidrosis. Through an incision approximately 3 cm long at the central axillary crease, the entire subcutaneous tissues containing apocrine glands were initially dissected with straight scissors within the axillary area, and then, the undermined apocrine glands were removed with curved scissors. The skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Negative pressure drains were placed, and intraoperative irrigation of the cavity through the drains with 20 ml of NaCl 0.9% or NaCl 10% left at site for 10 min applies different saline solutions in the same patients. The volumeofdrainage on the 1st postoperative day was 6.54±0.36 mL for the group B, which was significantly less than 15.23±0.42 mL for the group A (p < 0.05). The time of drain removal for the group B was 24 h, which was shorter than 48 h for the group A. In group B, 4 percent of axillae showed significant SF postoperatively, which was lower than the 20 percent of axillae associated with the group A (p < 0.05). The rate of incision infection for the group B was 2 percent, which was significantly lower than the 6 percent of axillae in the group A (p < 0.05). Two percent of axillae showed skin edge necrosis postoperatively in the group B, which was lower than the 10 percent of axillae associated with the group A (p < 0.05). IHSI enhances adhesion formation and reduces secretion rate in subcutaneous dissection space after axillary bromhidrosis surgeries, therefore enables early drain removal and prevents SF, incision infection and skin edge necrosis. As a result, reducing the pain of patients, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study.

Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.

Prospective Study to Evaluate Efficacy of Single Versus Double Drains in Breast Cancer Patients Undergoing Surgery.

Seroma formation is a common sequel following modified radical mastectomy (MRM), which hinders healing, may prolong hospital stay, and cause a delay in adjuvant treatment. Closed suction drains have been used to prevent formation of seroma; however, the use of a single drain in the axilla along with draining the mastectomy flaps and axilla separately remains a topic of debate. This prospective randomized dual-arm study was conducted in the Department of Endocrine Surgery. All female patients with carcinoma breast diagnosed on core tissue biopsy, undergoing modified radical mastectomy, upfront or post neoadjuvant systemic therapy were included. Patients were randomized into two groups. In the first group, a single drain was placed in the axilla whereas in the second group, a drain each was placed below the mastectomy flaps and the axilla. Patients' particulars and the weight of the mass excised along with the operative detailswere documented. The volume of the drain was recorded daily. The flap drain was removed on postoperative day 5 and the axillary drain was removed when the drain volume was less than 30mL/24h for 2 consecutive days. The period of drain placement, volume of drainage, volume of seroma (if formed), and other complications (if any) were recorded. Patients in the single drain group had a significantly earlier drain removal time as compared to those with double drains (p = 0.01). The number of patients in whom seroma formation had occurred was more in the double drain group, but the difference was not significant. The average volume of aspirated seroma fluid was insignificantly more in the single drain group. The only other complication noticed was flap necrosis-in 5% patients of the double drain group. Total volume of drainage (p < 0.0001) and type of drain (p = 0.0208) were associated with higher rates of seroma formation, whereas BMI (p = 0.0516), weight of excised breast mass (p = 0.407), and age (p = 0.6379) were not associated with the rate of seroma formation. Outcomes in terms of drain volume or seroma formation were statistically indifferent between the two groups. Still, use of only a single axillary drain should be promoted, keeping in mind the earlier drain removal period, better patient compliance, and reduced hospital stay.

Impact of microporous polysaccharide haemostatic agent on patients undergoing mastectomy or axillary dissection on seroma formation and timing of drain removal

Background: Seroma formation is a known complication following mastectomy and axillary lymph node dissection (ALND) leading to morbidity and financial implications for patients. ARISTATM AH has been designed to prevent postoperative seromas formation in vitro. Methods: We performed a single institution, single surgeon retrospective study from January 2017 to December 2022 in patients undergoing mastectomy/axillary dissection to evaluate seroma formation rates and timing of drain removal. Results: A total of 72 cases were included in our retrospective review of electronic medical records. Of these, 40 patients underwent ipsilateral mastectomies with sentinel node biopsies, 8 patients underwent bilateral mastectomies, and 18 patients underwent axillary dissections without concurrent mastectomy. Our analysis showed a non-significant decrease in seroma formation when ARISTATM AH was used intra-operatively (10%) compared to standard care (24%), (p=0.14). The ARISTATM AH group had a statistically significantly longer mean drain removal time than the standard care group (12.9 vs 7.6 days, p=0.002). Conclusions: There was a trend towards lower seroma formation and a significantly longer requirement for drain placement after mastectomy in ARISTATM AH group. Further research including randomised controlled multi-centre study evaluating the benefit of topical haemostatic agents in reducing seroma formation in breast surgery is warranted.

Analysis of retromuscular drain output and postoperative outcomes for heavyweight versus mediumweight polypropylene mesh following open ventral hernia repair

PurposeHeavyweight polypropylene (HWPP) mesh is thought to increase inflammatory response and delay tissue integration compared to mediumweight (MWPP). Reactive fluid volume (i.e., drain output) may be a reasonable surrogate for integration. We hypothesized that daily drain output is higher with HWPP compared to MWPP in open retromuscular ventral hernia repair (VHR).MethodsThis is a post-hoc analysis of a multicenter, randomized clinical trial conducted March 2017–April 2019 comparing MWPP and HWPP for VHR. Retromuscular drain output in milliliters was measured at 24-h intervals up to postoperative day seven. Univariate analyses compared differences in daily drain output and time to drain removal. Multivariable analyses compared total drain output and wound morbidity within 30 days and hernia recurrence at 1 year.Results288 patients were included; 140 (48.6%) HWPP and 148 (51.4%) MWPP. Daily drain output for days 1–3 was higher for HWPP vs. MWPP (total volume: 837.8 mL vs. 656.5 mL) (p < 0.001), but similar on days 4–7 (p > 0.05). Median drain removal time was 5 days for both groups. Total drain output was not predictive of 30-day wound morbidity (p > 0.05) or hernia recurrence at 1 year (OR 1, p = 0.29).ConclusionWhile HWPP mesh initially had higher drain outputs, it rapidly returned to levels similar to MWPP by postoperative day three and there was no difference in clinical outcomes. We believe that drains placed around HWPP mesh can be managed similarly to MWPP mesh.

Factors Affecting Drain Output in Oral Carcinoma.

Advanced oral carcinoma surgery results in large denuded areas leading to seroma and hematoma. Closed suction drains obliterate dead space and create negative pressure on wound bed. Non-placement or early removal of drain can lead to various complications, while placement for long duration can cause surgical site infection. The study aims to evaluate factors affecting postoperative neck drain volume, guiding surgeons for decision making for time of drain removal. The study comprised of 222 patients with oral squamous cell carcinoma who underwent primary tumor resection and neck dissection. Demographical, clinical, and surgical details were retrospectively analyzed. The mean age of patients was 49.1 years. Majority of patients had advanced disease requiring extensive surgery. Patients with radical neck dissection and those reconstructed with pedicled flap had statistically significant drain volume as compared to those with selective neck dissection and free flaps, respectively. Patients with longer duration of surgery, higher blood loss, low postoperative albumin value, and complications showed increased drain volume. Mean duration of drain removal was 7 days, and all drains were removed by day 10. Advanced stage primary disease, radical and modified neck dissections, PMMC flap reconstruction, longer duration of surgery, and higher blood loss had higher drain output. Thus, patient parameters, tumor factors, and surgery factors influence drain output and hospitalization. Diligent preoperative and perioperative assessment of various factors can aid trainee surgeons to make decisions for appropriate time for drain removal.

Comparison of Different Acellular Dermal Matrix in Breast Reconstruction: A Skin-to-Skin Study.

Since the early 2000s, acellular dermal matrix has been a popular adjunct to prepectoral breast reconstruction to enhance outcomes. The aim of this study was to investigate the differences in the postoperative course of 2 standard acellular dermal matrix products, AlloDerm SELECT Ready To Use and DermACELL. A prospective, patient-blind study of patients undergoing bilateral nipple and/or skin-sparing mastectomies with either tissue expander or silicone implant insertion between 2019 and 2022 were selected for this study. The study design used patients as their own controls between 2 products randomly assigned to the left or right breast. Outcomes between the products included average time for drain removal, infection rate, seroma rate, and incorporation rates. The prospective clinical data of 55 patients (110 breasts) were recorded for 90 days. There were no significant differences between drain removal time, average drain output, or seroma aspiration amount. A higher percentage of seromas was recorded in the breasts with AlloDerm (30.91%) compared with breasts containing DermACELL (14.55%, P < .05), and a statistically significant difference between the incorporation rates of AlloDerm (93.4%) and DermACELL (99.8%, P < .05) was observed. Irrespective of patient demographic disparities, both products had a 94.55% success rate for reconstruction outcomes. AlloDerm was determined to have a higher incidence of seromas as a postoperative complication and a trend to lower incorporation.

Approach to mediastinal masses: a comparison of open surgery and uniportal video-assisted thoracoscopic surgery techniques

Aims: This study aimed to compare perioperative and postoperative outcomes in patients who underwent uniportal video-assisted thoracoscopic surgery (U-VATS) and open surgery for mediastinal mass resection. Methods: A total of 62 patients who underwent mediastinal mass resection in the Thoracic Surgery Clinic were included. The patients were separated into the open surgery group (n=30) and the U-VATS group (n=32). The groups were compared in terms of perioperative and postoperative outcomes including operative time, blood loss, chest tube removal time, drainage volume, pain, and hospital stay. Results: The distributions of age and gender were similar between the groups. Median operation time (120 vs. 180 minutes, P &lt; 0.001), median intraoperative blood loss (50 vs. 100 mL, P &lt; 0.001), median time of chest drain removal (4 vs. 6 days, P &lt; 0.001) and median postoperative drainage volumes were lower in the U-VATS group than the open surgery group. The U-VATS group exhibited a lower VAS score, return time to daily activity (1 vs. 4 days, P &lt; 0.001) and length of hospital stay (4 vs. 6 days, P &lt; 0.001). A postoperative myasthenic crisis was not observed in all cases. One thymoma patient in the open surgery group had a recurrence, but not in the U-VATS group. Conclusion: The U-VATS approach had better intraoperative safety and lower postoperative outcomes than open surgery. U-VATS, which has the potential to enhance postoperative recovery and quality of life, may be a safe and effective treatment option for patients with mediastinal mass resection.

Single versus Double Drainage for Immediate Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis.

Reports evaluating plastic surgeons' practices indicate there are conflicting trends regarding the use of one or two drains for implant-based breast reconstruction (IBBR). Our study aimed to perform a matched cohort analysis to examine the postoperative outcomes and complications of immediate IBBR with tissue expander (TE) using two drains versus a single drain. A propensity score-matched analysis (nearest neighbor, 1:1 matching) of immediate reconstructions using two versus one drain was conducted. Female patients undergoing immediate two-stage IBBR with TEs between January 2011 and May 2021 were included. The covariables were as follows: BMI, mastectomy weight, lymph node surgery, TE surface, plane of reconstruction, use of acellular dermal matrix products, fluorescence imaging use, and intraoperative TE volume. After matching using propensity scores, 192 reconstructions were included in the final analysis: 96 in each group. The rate of 30-day complications and overall complications during the first phase of IBBR were comparable between groups. The time for drain removal, time to initiate and finalize expansions, and time for TE-to-implant exchange were comparable between groups. Diabetes (OR 3.74, p = 0.025) and an increased estimated blood loss (OR 1.004, p = 0.01) were the only independent predictors for seroma formation. In this matched cohort analysis evaluating the role of one versus two drains for two-stage IBBR, we found a comparable rate of complications and surgical outcomes between the two cohorts. Using two drains for immediate IBBR needs to be tailored depending on intraoperative findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Recent evidence for subcutaneous drains to prevent surgical site infections after abdominal surgery: A systematic review and meta-analysis.

Surgical site infections (SSIs) increase mortality, hospital stays, additional medical treatment, and medical costs. Subcutaneous drains prevent SSIs in gynecological and breast surgeries; however, their clinical impact in abdominal surgery remains unclear. To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis. The database search used PubMed, MEDLINE, and the Cochrane Library. The following inclusion criteria were set for the systematic review: (1) Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains; and (2) Studies that described clinical outcomes, such as SSIs, seroma formation, the length of hospital stays, and mortality. Eight studies were included in this meta-analysis. The rate of total SSIs was significantly lower in the drained group (54/771, 7.0%) than in the control group (89/759, 11.7%), particularly in gastrointestinal surgery. Furthermore, the rate of superficial SSIs was slightly lower in the drained group (31/517, 6.0%) than in the control group (49/521, 9.4%). No significant differences were observed in seroma formation between the groups. Hospital stays were shorter in the drained group than in the control group. Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation. The timing of drain removal needs to be reconsidered in future studies.

Preferring Lateral Video Endoscopic Inguinal Lymph Node Dissection Over Classic Video Endoscopic Inguinal Lymph Node Dissection in Squamous Cell Carcinoma of Penis: Lessons Learnt from Twenty-One Patients at a Single Center.

Inguinal lymphadenectomy is essential for staging and disease control. Minimally invasive techniques are recently replacing open techniques to reduce complications. We present our experience and lessons learnt from 21 patients who underwent lateral video endoscopic inguinal lymphadenectomy (L-VEIL) for penile malignancy. All patients above 18 years of age with histopathology-confirmed squamous cell carcinoma penis with stages ≥ T1b and T1a with persistent lymphadenopathy who underwent L-VEIL over a period of 2 years (2020-2022) were included. The data were analyzed on the basis of intraoperative and postoperative complications, lymph node yield, hospital stay, and histopathology report. Forty-one lower limbs of 21 patients underwent L-VEIL during the abovementioned period. Median age was 52 years. Mean operative time (on 1 side) was 80 minutes. Median lymph node yield per side was 7.2. Intraoperatively, 1 patient had a vascular injury at the saphenofemoral junction, requiring conversion to open. Postoperative complications were superficial surgical site infection (n=4), lymphedema (n=1), and lymphocoele (n=3), one of which was drained by pigtail catheter. One patient required exploration on the second postoperative day because of vascular injury. Average duration of hospital stay was 3 days. The median time of drain removal was 13 days. Histopathology suggested seminoma in 1 patient and mature teratoma in 1 patient; the rest of the patients' reports were negative for malignancy. The L-VEIL is safe and feasible, and there is a reduction (~30%) in complications; oncological outcomes are also not affected. It has better ergonomics, resulting in ease and comfort for surgeons when compared with classical VEIL.

Drain fluid volume combined with amylase level predicts clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A retrospective clinical study.

Several indicators are recognized in the development of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). However, drain fluid volume (DFV) remains poorly studied. We aimed to discover the predictive effects of DFV and guide clinical management. We retrospectively reviewed the clinical data of patients that received PD between January 2015 and December 2019 in a high-volume center. DFV was analyzed as a potential risk factor and postoperative short-term outcomes as well as drain removal time were compared stratified by different DFV levels. Receiver operating characteristic curves and area under curves (AUC) were compared for DFV alone and DFV combined with drain fluid amylase (DFA). Subgroup analysis of DFV stratified by DFA evaluated the predictability of CR-POPF. CR-POPF occurred in 19.7% of 841 patients. Hypertension, postoperative day 3 (POD3) DFA≥300U/L, and POD3 DFV≥30mL were independent risk factors, while pancreatic main duct diameter ≥3mm was a protective factor. POD3 DFV≥30mL increased the overall occurrences of CR-POPF and major complications (P=0.017; P=0.029). POD3 DFV alone presented a low predictive value (AUC 0.602), while POD3 DFV combined with DFA had a high predictive value (AUC 0.759) for CR-POPF. Subgroup analysis showed that the combination of POD3 DFV≥30mL and DFA≥300U/L led to higher incidences of CR-POPF (P=0.003). CR-POPF is common after PD, and high DFV combined with DFA may predict its occurrence and facilitate appropriate management.

Short-term efficacy of additional laparoscopic-assisted radical gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer.

To investigate short-term efficacy of direct laparoscopic-assisted radical gastrectomy (LAG) versus non-curative endoscopic submucosal dissection (ESD) plus additional LAG for early gastric cancer. 286 patients were retrospectively assigned into two groups: direct LAG group (n = 255) and additional LAG (ESD plus LAG, n = 31) group. A 1:2 propensity score matching was performed to equalize relevant confounding factors between two groups for analysis. Ninety-three patients were successfully matched, including 62 in the direct LAG group and 31 in the additional LAG group. A significant (P = 0.013) difference existed in the drainage removal time between the additional LAG and direct LAG group (7 d vs. 6 d). Age, sex, tumor location and surgical approach were significantly (P < 0.05) associated with complications, with age ≥ 60 years (P = 0.002) and total gastrectomy (P = 0.011) as significant independent risk factors. A significant (P = 0.023) difference existed in the surgical time between the early and late groups (193.3 ± 37.6 min vs. 165.5 ± 25.1 min). Additional LAG (D1 + lymphadenectomy) after ESD may be safe and effective even though non-curative ESD may prolong the drainage removal time and increase the difficulty of surgery.

Comparative Evaluation of Onlay vs Sublay Mesh in Treatment of Ventral Hernias

Abstract Background Hernias of the anterior abdominal wall, or ventral hernias have a various type that can be categorized into primary ventral hernias which include two subtypes lateral ventral hernia, and midline ventral hernias, and incisional hernias (acquired hernias) is another type according to the location, occur at the site of a pervious surgical scar. Objective To compare the outcome of the onlay versus sublay mesh repair for ventral hernias in terms of mean operative time, frequency of post-operative wound infection, seroma formation, hematoma formation, flap necrosis, mesh infection, hospital stay and time for drain removal. Patients and Methods This study will be conducted on 30 patients presenting to Ain shams University hospitals with uncomplicated ventral hernias starting from February 2021 till July 2021. Results Regarding the post operative complications, Seroma formation was more in the onlay group and this was statistically significant. Other post operative complications like wound infection, flap necrosis, Mesh infection, hematoma formation was more in the onlay group but were found to be statistically insignificant in the present study. Regarding the time taken for drain removal was more in the onlay group and this was statistically significant. Conclusion Sublay mesh repair is a good alternative to onlay mesh repair. This study advocates this method of ventral hernia repair, as it is applicable to all sites of ventral hernia. The mesh is mostly hidden and anchored behind the rectus sheath, the complication rate is low, and there is low recurrence rate. Finally, we suggest carrying out more trials on the sublay mesh repair technique to include bigger number of cases and longer period of follow-up.

Breast Conserving Surgery versus Mastectomy: Overall and Relative Survival – A Population Based Study by Ain Shams University Hospital

Abstract Background Breast cancer is one of the most frequently diagnosed cancers worldwide and is a major contributor to cancer mortality in women. Breast cancer is treated with a multidisciplinary approach involving surgical oncology, radiation oncology, and medical oncology, which has been associated with a reduction in breast cancer. Aim of the Work The aim is to compare the outcome of Ain Shams university hospitals patients treated by mastectomy and BCS. The comparison takes the available prognostic variables into a multivariate analysis and includes an intention to treat analysis. Patients and Methods We randomized 20 patients in a retrospective cohort study who received either modified radical mastectomy or breast conserving surgery in period 2019-2020. We compared the outcome of patients after 1-2 year as regard post-operative hospital stay, time of Redivac drain removal, development of post-operative seroma, wound infection, wound hematoma, wound dehiscence, development of ugly scar with evaluation of recurrence be clinical examination and ultrasound follow up and take in consideration the type of adjuvant therapy that has been taken. Results We found that there's no significance between Modified radical mastectomy and conservative breast surgery according to recurrence, post-operative adjuvant therapy and hospital stay with small significance according to post-operative wound healing, seroma, hematoma, infection, wound dehiscence with better outcome to the conservative breast surgery. We found also high significance between the two invasive procedures according to the patient satisfaction with high satisfaction to the conservative breast surgery mostly due to the preservation of the breast and less wound complications Conclusion Both Breast cancer invasive procedures as regard mastectomy and conservative breast surgery have the same results according to recurrence, hospital stay and adjuvant therapy. Conservative breast surgery is better than mastectomy when indicated as regard wound complications and preservation of the breast tissue which increase patient satisfaction towards it.

Comparative Study between the Effect of the Ultrasound Dissector (the Harmonic) versus Monopolar and Bipolar Electrocautry in Reducing Seroma Formation Post-Conservative Breast Surgery

Abstract Background Breast cancer, according to national cancer institute, is the commonest cancer in women in Egypt, It represents 37% of all female cancers among Egyptian females cancers, seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery (monoplar and bipolar) in reducing seroma formation post conservative breast surgery. Patients and Methods This prospective randomized study was conducted on female patients with breast tumours at the General Surgery Department at Ain Shams University Hospitals starting from November 2020 to May 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained. Results Our study included 60 patients, in whom a conservative breast surgery and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 20) or monopolar electrocautery (n = 20) or bipolar electrocautery (n = 20). Our mean age was 45.47±9.14 years (19-60 years). 10/60 patients (16.6%) had positive family history of mammary cancer, 18/60 patients were diabetic (30%), 23/60 patients were hypertensive (38%), 10/60 patients received neoadjuvant chemotherapy (10%). The mean lesional size was 2.9 ±1.03 cm (1.5-6.2 cm).the mean safety margin was 2.23±0.37 (1.5-3 cm). Operation timing was longer in bipolar electrocautry being (91.90 ± 3.14 minute) than monopolar elctrocautery being (83.35± 3.41 minute), while in harmonic group operation timing being (51.65 ± 5.02 minute).in addition intraoprative blood loss was significant large amount in monopolar electrocautery 75.15 ± 3.12 ml, while in harmonic dissection compared with bipolar electrocautery mean intraoprative blood loss was no significant (52.00 ± 4.18 ml vs 55.80 ± 9.89 ml pvalue =0.055). moreover there was asignificant reduction in the mean time of drain removal (2.90 ± 0.64 day in harmonic dissector), while in bipolar electrocautery 4.95 ± 0.69 day and longest mean time in drain removed in monopolar electrocautery 6.85 ± 0.37 day). And the incidence of seroma formation after drain removal is significant in monopola relectrocautery 58.3%. p-value =0.040, while in harmonic dissection compared bipolar electrocautery incidence of seroma formation after drain removal (16.7% vs 25.0%), this mean that harmonic dissector is low incidence of seroma formation. Conclusion Harmonic dissection technique leads to significant decreases in intraoperative blood loss, operative time, mean time of drain removal and postoperative seroma in terms of shorter drain duration and better quality of life. Here, we recommend the use of the harmonic dissection technique in conservative breast surgery.

A Comparative Study between Onlay versus Sublay Mesh Repair in Treatment of Midline Incisional Hernia

Abstract Background Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study The aim of this study was to compare between onlay and sublay mesh repairs in treatment of midline incisional hernia regarding the operative technique and postoperative complications. Patients and Methods This randomized controlled prospective comparative study was conducted in general surgery department Ain-Shams University Hospital and Damanhour Medical National Institute in the period between November 2019 and April 2020. It included 40 patients with Midline incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results The mean operative time in group A was 104.2 minutes and in group B was 82.9 minutes. The mean time of drain removal in group A was 4.3 days while in group B was 13.6x days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 4 patients in group B (20%). The other postoperative complications were comparable in both groups. During 6 months of follow up, hernia recurrence didn’t occurs in any patient in group A nor group B. Conclusion Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.