Duration Of Drainage Research Articles

A retrospective controlled study of postoperative fever after posterior lumbar interbody fusion due to degenerative lumbar disease.

Background:Postoperative fever is a common feature of spinal surgery. When fever occurs postoperatively in patients, surgeons are eager to rule out an infection. There are many reports about postoperative fever and infection; however, only a few have described the relationship between degenerative spinal disease and postoperative fever. This study aimed to investigate the causes of postoperative fever in patients with degenerative lumbar disease undergoing posterior screw fixation and interbody fusion and compare patients with non-pathologic fever and infected febrile patients.Methods:From March 2015 to February 2016, 263 patients with degenerative lumbar disease underwent posterior lumbar screw fixation and interbody fusion surgery in our institution. We performed risk factor analysis by categorizing patients as afebrile and febrile. Comparisons were made between afebrile patients and patients with non-pathologic fever, and an analysis was performed between patients with non-pathologic fever and patients with febrile infection. We compared each group by examining the demographic factors before surgery, surgery features, drain duration, and postoperative transfusion. The postoperative day (POD) of fever onset, postoperative fever duration, and blood sample results in patients with fever were investigated.Results:The drain duration was found to be an important factor between the afebrile febrile groups and between the non-pathologic fever and afebrile groups. POD of fever occurred earlier in the non-pathologic group than in the infection group (p = 0.04), and the duration of fever was shorter in the non-pathologic fever group than in the infection group (p = 0.01). Higher procalcitonin levels were observed at POD 5 in the infection group than in the non-pathologic fever group. (p < 0.01) The accidental dural rupture rate was higher in the infected group (p = 0.02); this was thought to be caused by the long non-ambulatory period after surgery.Conclusion:This study identified risk factors and differences between infectious diseases associated with postoperative fever. A significant risk factor for postoperative non-pathological fever was a shorter catheter drainage period. Fever after 3 days, fever for more than 4 days and higher procalcitonin levels after surgery suggest infection.

Deep Fat Saving Elevation of the Superficial Circumflex Iliac Artery Perforator Flap.

Background and Objectives: Prolonged drain stay and lymphorrhea are often problems at the donor site of the superficial circumflex iliac artery perforator (SCIP) flap. This study aimed to introduce a novel technique of the SCIP flap elevation: Deep Fat Saving (DFS) technique. Materials and Methods: Thirty-two patients who underwent the SCIP flap transfer were divided based on the flap-elevated layer: above the deep fascia or the Camper fascia saving the deep fat. The duration of drain stay and the rates of flap survival and donor-site complications were compared between the groups. The inverse probability weighting (IPW) method was conducted to balance confounders. Results: By IPW, two balanced pseudo-populations were created: DFS = 33.9 and Conventional = 31.3. There were no significant differences in the rate of flap survival (DFS: 100% verses Conventional: 95.8%, p = 0.32) and donor site complications (DFS: 2.4% versus Conventional: 1.3%, p = 0.68, respectively). The duration of drain stay was shorter in the DFS group (weighted median: 6 versus 8 days; weighted difference: −1.6 days (95% confidence interval: −2.8 to −0.4), p = 0.01). Conclusions: An SCIP flap can be reliably harvested using the Deep Fat Saving technique.

Primary hyperoxaluria type 1: urologic and therapeutic management.

ABSTRACTWhile the surgical approaches available in primary hyperoxaluria (PH) are common to all patients requiring intervention for urolithiasis, the indications for treatment and their corresponding toxicities are unique. Being a rare disease, we are guided by case series. This review summarizes the available literature highlighting the important disease-specific considerations. Shockwave lithotripsy (SWL) is of particular interest. It is generally the first-line treatment for stones in children, but here the stones produced will be relatively resistant to fragmentation. In addition, there are concerning reports in children of sudden unilateral decline in function in the treated kidney as measured by nuclear renography. Percutaneous nephrostolithotomy might intuitively seem favorable given the shortest drain duration and the ability to treat larger stones efficiently but, similar to SWL, rapid chronic kidney disease (CKD) progression has been seen postoperatively. Ureteroscopy is therefore generally the safest option, but considerations regarding stent encrustation, the growth of residual fragments and the large volume of stone often faced may limit this approach. The surgeon must balance the above with consideration of the patient's CKD status when considering a plan of monitoring and treating stones in PH.

A Retrospective Study from a Single Center of 208 Patients with Unilateral Chronic Subdural Hematoma to Compare Outcomes Following Burr Hole Craniotomy and Hematoma Drainage Within 48 Hours and Between 48 Hours and 5 Days

BackgroundThis retrospective study from a single center aimed to compare patient outcomes following burr hole craniotomy (BHC) and hematoma drainage within 48 hours and between 48 hours and 5 days in 208 patients with unilateral chronic subdural hematoma (CSDH).Material/MethodsPatients were divided into 2 groups according to the duration of drainage: early (1 or 2 days, n=100) and late (3–5 days, n=108) drain removal. We compared the clinical outcomes, recurrence rate, time to recurrence, and complications between the groups. Quantitative analysis of computed tomography parameters at various time points (postoperative, day of drain removal, and postoperative day 7) was also performed to compare radiologic outcomes.ResultsClinical outcomes and recurrence rate were similar in both groups. We found no significant differences in radiologic outcomes of both groups through all chronologies, although the total drainage volume was significantly greater in the late removal group (P<0.001). The incidence of surgical complications was significantly higher in the late drain removal group (8% vs 22.2%, P=0.007). Specifically, contralateral subdural effusion (CSE) tended to occur more frequently in the late removal group (2% vs 8.3%, P=0.038).ConclusionsFollowing BHC and hematoma drainage for unilateral CSDH, maintaining the subdural drain for more than 48 hours did not improve patient outcomes or reduce the recurrence of hematoma, but increased the surgical complications, including CSE.

Endoscopic ultrasound-guided drainage of peripancreatic fluid collections: What impacts treatment duration?

BackgroundPeripancreatic fluid collections (PFCs) are complications resulting from acute or chronic pancreatitis and require treatment in certain clinical conditions. The present study aimed to identify the factors influencing the duration of endoscopic ultrasound (EUS)-guided drainage of symptomatic pancreatic pseudocysts (PPCs), walled-off necrosis (WON), and acute necrotic collections (ANCs). MethodsThis was a retrospective cohort study of 68 patients with PFCs who underwent EUS-guided drainage. The timing and duration of EUS-guided drainage of various PFCs (ANC, WON, and PPCs) were compared, and the factors influencing the duration of endoscopic treatment were identified. ResultsThe mean time to first EUS-guided PFC drainage since the acute pancreatitis episode was 372.0, 505.0, and 18.7 days for WON, PPC, and ANC, respectively, and the mean duration of treatment was 90, 60, and 63 days, respectively. A disconnected pancreatic duct, a history of percutaneous drainage, and an infected PFC were identified as factors influencing the treatment duration. A positive correlation was observed between the treatment duration and patients’ age. Patients with a disconnected pancreatic duct had to undergo more procedures. In patients with PPC, clinically successful drainage was more frequently achieved after a single procedure without the need for repeated procedures than in those with WON (90% vs. 59%, P = 0.01). ConclusionsPatients with a history of percutaneous drainage, disconnected pancreatic duct, or PFC infection may require longer endoscopic treatment.

The Effect of Dermal Suspension on Early Complications After Vertical Reduction Mammoplasty.

Reduction mammoplasty is frequently performed in plastic surgery clinics. The vertical technique can be performed using several different pedicles, including superior, superomedial, medial, and lateral. For patients with large breasts, using a medial pedicle is recommended as a safer approach. Superficial wound dehiscence is common with all breast reduction techniques. The present study compared early complications in patients who underwent reduction mammoplasty with superior pedicle, medial pedicle, or medial pedicle with dermal suspension performed by the same surgeon. The patients were evaluated in terms of age, weight, height, pedicle type and technique used for vertical reduction mammoplasty, resected tissue mass, suprasternal notch (SSN) to nipple-areola complex (NAC) distance, NAC transposition distance, and drain duration. Pairwise comparisons revealed that wound dehiscence along the inframammary fold (IMF) was significantly less frequent in the superior pedicle group than the medial pedicle without suspension group (p = 0.018). Although not statistically significant, using the suspension method in medial pedicle procedures reduced the rate of IMF wound dehiscence from 32.4 to 25%. Delayed IMF wound healing was associated with the amount of resected tissue (p = 0.004) but not with age, BMI, SSN-to-NAC distance, NAC transposition distance, or drain duration. Suspending the medial pedicle from the chest wall reduced the rate of IMF wound dehiscence. 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 .

Association of External Ventricular Drain Duration and Outcomes in Aneurysmal Subarachnoid Hemorrhage: a Single Center Study (P12-10.003)

Association of External Ventricular Drain Duration and Outcomes in Aneurysmal Subarachnoid Hemorrhage: a Single Center Study (P12-10.003)

Fontan procedure on deep hypothermic circulatory arrest: Short-term results and technique.

Various operative strategies are described for the Fontan procedure. In this study, we describe our short-term results and technique of Fontan procedure on cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). This was a retrospective study of 32 patients, median age of 6 years (4-19 years) and median weight of 20 kg (13-51 kg), who underwent Fontan procedure on CPB and DHCA from July 2016 to July 2021. The median CPB time was 125 min (77-186 min), the median DHCA time was 42 min (27-50 min), and the median Fontan pressure was 14 mmHg (10-18 mmHg). The median time to extubation was 4 h (1-20 h), the duration of chest tube drainage was 8 days (5-24 days), and the median intensive care unit stay was 4 days (3-8 days). The presence of heterotaxy was associated with longer duration of pleural drainage (P = 0.01). There was no operative mortality and no major adverse events such as seizures, gross neurological deficits, or arrhythmias in the postoperative period. Fontan procedure can be safely performed on CPB and DHCA with good operative results. This operative strategy may be used in special circumstances like in patients with situs and systemic venous anomalies and those requiring repair of a complex intracardiac defect. Long-term follow-up will be required to evaluate if this strategy has any impact on the neurodevelopmental outcome and the long-term sequelae of Fontan.

Risk Prediction of Central Nervous System Infection Secondary to Intraventricular Drainage in Patients with Intracerebral Hemorrhage: Development and Evaluation of a New Predictive Model Nomogram

BackgroundCurrently no reliable tools are available for predicting the risk of central nervous system (CNS) infections in patients with intracerebral hemorrhage after undergoing ventriculostomy drainage. The current study sought to develop and validate a nomogram to identify high-risk factors of CNS infection after ventriculomegaly drain placement for intracerebral hemorrhage.MethodsA total of 185 patients with intracerebral hemorrhage who underwent ventriculoperitoneal drainage were enrolled to the current study. Patients were divided into a CNS infection group (20 patients) and a non-CNS infection group (165 patients). The baseline data from both groups was used to develop and evaluate a model for predicting the likelihood of developing CNS infection after ventriculoperitoneal drain placement for intracerebral hemorrhage.ResultsThe finding showed that operative time, intraventricular drainage duration, postoperative temperature, white blood cell count in cerebrospinal fluid (CSF), neutrophils ratio in CSF, Red blood cell count in CSF, and glucose content in CSF were correlated with CNS infection. A nomogram for predicting the risk of CNS infection was constructed based on these variables. The c-index and the AUC of the ROC curve was 0.961, showing good discrimination. Clinical decision curve analysis indicated that the nomogram clinical application ranged between 1 and 100%. The clinical impact curve was generated to set with a threshold probability of 0.5.ConclusionThe nomogram reported in the current study can be used by clinicians to identify patients likely to have secondary CNS infections, so that clinicians can better treat these patients at earlier stages.

Feasibility of double sleeve lobectomy after neoadjuvant chemotherapy in patients with non-small-cell lung cancer.

This study intends to appraise the feasibility of double sleeve lobectomy after neoadjuvant chemotherapy in central non-small-cell lung cancer with bronchovascular aggression. This retrospective study included non-small-cell lung cancer patients who received double sleeve lobectomy from January 2014 to June 2020. Patients were divided into 2 groups: the neoadjuvant chemotherapy group and the non-neoadjuvant chemotherapy group. Demographic data and perioperative outcomes were compared between these 2 groups. Of the 110 patients who received double sleeve lobectomy during this period, 35 patients (31.8%) received neoadjuvant chemotherapy. Compared with the non-neoadjuvant chemotherapy group, patients who received neoadjuvant chemotherapy were associated with younger age (P = 0.026), smaller pathologic tumour size (P = 0.005), higher forced expiratory volume in 1 s (P = 0.007), higher forced expiratory volume in 1 s of predicted value (P = 0.005) and higher clinical stage (P < 0.001). In the neoadjuvant chemotherapy group, 18 patients (51.4%) attained a partial response and 17 patients (48.6%) achieved stable disease. The postoperative hospital stays (P = 0.042) and chest tube drainage duration (P = 0.030) were longer in the neoadjuvant chemotherapy group and other perioperative performances were similar between these 2 groups. No statistically significant difference was reported in postoperative complications and mortality between these 2 groups. The intraoperative performance and postoperative outcomes of double sleeve lobectomy following neoadjuvant chemotherapy were similar to direct surgery, indicating that double sleeve lobectomy after neoadjuvant chemotherapy is feasible and safe in central lung cancer involving both the pulmonary artery and bronchus.

Complex vs. simple segmentectomy: comparing surgical outcomes in the left upper division.

Lung segmentectomy is an option for the treatment of noninvasive or minimally invasive lung cancer. For tumors located in the left upper division (LUD), LUD trisegmentectomy (S1+2 + S3) is frequently performed as a sublobar resection because of its technical simplicity. However, the differences in surgical outcomes between simple and complex segmentectomies remain unclear. We compared the surgical outcomes and frequency of postoperative complications of LUD trisegmentectomy (simple group) with those of complex segmentectomy (other than LUD trisegmentectomy; complex group) for pulmonary lesions using three-dimensional computed tomography between 2010 and 2021. In total, 118 patients were included: 65 in the simple group and 53 in the complex group (S1+2: 25, S3: 15, others: 13). There were no significant differences in surgical time or duration of postoperative chest drainage. However, the blood loss volume was significantly smaller in the complex group than in the simple group (12 vs. 36mL, p = 0.023), and major complications tended to occur less frequently in the complex group than in the simple group (3.8 vs. 13.8%, p = 0.061). Among patients who underwent intentional segmentectomy for primary lung cancer (n = 61), major complications were significantly less common in the complex group (p = 0.006). Complex segmentectomy can be performed safely under the guidance of three-dimensional CT. Complex segmentectomy itself is not a risk factor for postoperative complications when the intersegmental planes are sufficiently recognized and accurately cut.

Short-term outcomes of bronchoplastic lobectomies performed from video-assisted thoracoscopic and thoracotomic approaches

The OBJECTIVE of this study was to evaluate the short-term outcomes of bronchoplastic lobectomies performed from video-assisted thoracoscopic (VATS) and thoracotomic approaches and to identify factors affecting the course of the early postoperative period.METHODS AND MATERIALS. Out of 398 patients underwent surgical resection in the Center for Intensive Pulmonology and Thoracic Surgery of the SPbSBHI «City multidisciplinary hospital № 2» from 2014 to 2021 for malignant lung neoplasms, 27 patients with bronchoplastic lobectomy were included in the retrospective study. Patients were divided into two groups depending on surgical approach: group I (n=17) included patients operated via thoracotomic approach; group II (n=10) included patients who underwent VATS surgeries. The groups were similar in gender, age, smoking history, Body Mass Index, concomitant pathology, functional status and stage of the disease. Surgical intervention included ipsilateral systematic lymph dissection and bronchoplastic lobectomy.RESULTS. There were no significant differences in time of operation, blood loss, duration of drainage of the pleural cavity, incidence of postoperative complications, length of hospital stay, number of dissected lymph nodes between the groups. Factor analysis of the influence of pre- and intraoperative factors on the development of postoperative complications showed that the risk of a complicated course of the postoperative period significantly decreased at normal values of FEV1 and FVC (OR=0.942, p&lt;0.05; OR=0.932, p&gt;&lt;0.05) and increased in the presence of adhesions (obliteration of the pleural cavity more than 50%), requiring total pneumolysis, and the absence of interlobar fissures (OR=5.5, p&gt;&lt;0.05; OR=6.5, p&gt;&lt;0.05). In multivariate analysis, strong adhesions in the pleural cavity turned out to be an independent unfavorable prognostic factor for the development of postoperative complications (OR=8.567, p&gt;&lt;0.05). CONCLUSION. The use of VATS approach does not increase the incidence of complications after bronchoplastic lobectomies. In patients with FEV1&gt;84.9 %)CONCLUSION. The use of VATS approach does not increase the incidence of complications after bronchoplastic lobectomies. In patients with FEV1&gt;84.9 % and FVC&gt;101.2 %, the risk of complications after bronchoplastic lobectomies is confirmed lower. Adhesions in pleural cavity requiring total pneumolysis is an independent unfavorable factor in the development of postoperative complications.

A Comparative Study of Video-Assisted Thoracoscopic Surgery Versus Median Sternotomy Thymectomy in Myasthenia Gravis

Background: Thymectomy is a standard treatment for myasthenia gravis (MG) patients. Although there are different approaches for thymectomy available, the standard approach is still known as a median sternotomy. Currently, the video-assisted thoracoscopic (VATS) approach is increasing in popularity. It has shown benefits in less blood loss, less postoperative pain, and improvement of recovery after surgery. However, there are still controversies in the outcomes of these two approaches. Objective: To compare perioperative and neurological outcomes of thymectomy between the median sternotomy approach and the VATS approach. Materials and Methods: One hundred twenty-three patients underwent thymectomy between January 1, 2012 and December 30, 2020 and were enrolled in the present retrospective study. They were classified into two groups depending on the approach of the surgery. The perioperative and neurological outcomes were analyzed and compared between the two groups. The analyses were performed using students’ t-test, Mann-Whitney test, chi-square, or Fisher’s exact test. Results: There were 72 patients in the median sternotomy group and 51 patients in the VATS group, and no death in both groups. There were also no significant differences between the two groups regarding surgical time, postoperative pain, postoperative complications, and neurological outcomes. Intraoperative blood loss, intercostal drainage volume and duration, and length of hospital stay were significantly less in the VATS group. Complete remission was significantly higher in VATS group. The median follows up time was significantly longer in the median sternotomy group. Conclusion: The VATS approach for thymectomy had shown good outcomes, which were not inferior to the median sternotomy approach. Keywords: VATS Thymectomy; MG; Thymoma; Thymectomy; Minimally invasive thymectomy; Myasthenia gravis; Left VATS thymectomy; Subxiphoid VATS thymectomy; Anterior mediastinal tumor; Anterior mediastinal mass

Updated Evaluation of Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis.

ObjectivesRobot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) are the two principal minimally invasive surgical approaches for patients with lung cancer. This study aimed at comparing the long-term and short-term outcomes of RATS and VATS for lung cancer.MethodsA comprehensive search for studies that compared RATS versus VATS for lung cancer published until November 31, 2021, was conducted. Data on perioperative outcomes and oncologic outcomes were subjected to meta-analysis. PubMed, Web of Science, and EMBASE were searched based on a defined search strategy to identify eligible studies before November 2021.ResultsTwenty-six studies comparing 45,733 patients (14,271 and 31,462 patients who underwent RATS and VATS, respectively) were included. The present meta-analysis showed that there were no significant differences in operative time, any complications, tumor size, chest drain duration, R0 resection rate, lymph station, 5-year overall survival, and recurrence rate. However, compared with the VATS group, the RATS group had less blood loss, a lower conversion rate to open, a shorter length of hospital stay, more lymph node dissection, and better 5-year disease-free survival.ConclusionsRATS is a safe and feasible alternative to VATS for patients with lung cancer.

To Drain or Not To Drain an Inflatable Penile Prosthesis Implantation? A Multi-institutional Experience Tracking Scrotal Hematoma and Infection Occurrence

ABSTRACT Introduction Although the placement of a drain after inflatable penile prosthesis (IPP) implantation has become a current recommendation by many surgeons, some institutions still disagree believing drainage to be a potential source of infection. Objective We hereby present our data to defy this belief and to add to the body of evidence supporting postoperative (PO) drainage. Furthermore, we attempt to define the optimal duration of drainage. Methods Our subjects underwent IPP implantation by four European high volume surgeons. All implantations were performed via the penoscrotal access. Only virgin cases were included. We divided our patients into 3 groups: Group 1: no-drain (n=60), Group 2: 24-hour drain (n=60) and Group 3: 72-hour drain (n=60). All patients received similar perioperative antibiotics according to clinical guidelines. Surgical outcomes such as presence or absence of PO scrotal hematoma and infection were evaluated and compared between the 3 groups. We defined hematoma as a scrotal swelling correlated with evidence of scrotal free floating fluid on ultrasound examination. The ultrasound was done after 24 hours and on the 3rd and 10th PO days. Overall PO follow up was for 80 days. Results There were no significant differences in age, BMI, operative time, medical comorbidities among our study groups. The patients from Group 3 developed significantly less hematoma compared to Groups 1 and 2. The exact distribution of hematoma incidence was greatest in Group 1: n=12 (20%, p=0.005) followed by Group 2: n=8 (13.3%, p=0.05) and least in Group 3: n=1 (1.7%, p=0.002). Four patients in the no-drain group (6.7% p=0.005) developed IPP associated infection requiring device removal. All four had a hematoma prior to the infection. Groups 2 and 3 were infection-free. Conclusions Prolonged drainage up to 72 hours after virgin IPP implantation significantly reduces hematoma rates without the increased risk of drain-associated infections. Moreover, we believe that the development of a scrotal hematoma, by itself, may be a potential cause for surgical site infection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

Drain Volume Output Following IPP Implantation: An Analysis by Surgical Approach

ABSTRACT Introduction Inflatable penile prosthesis (IPP) is the gold standard therapy in the surgical treatment of erectile dysfunction. Hematoma and seroma formation have been described following implantation. These fluid collections may be a significant source of patient pain and infection. Use of closed system drains after penile implantation has been described previously to manage these proactively, and are typically removed on post-op day one. Upon previous analysis, we demonstrated that an extended, three-day postoperative drain course resulted in a modest but significant decrease in postoperative use of pain medication without changing infection rates. Objective Herein, we evaluated post-operative drain output volumes to detect differences based on operative approach. Methods A total of 151 patients had IPP placement by a single surgeon between November 2017 and November 2019. After excluding patients who underwent additional procedures for Peyronie's disease, those who had a concomitant procedure for post-prostatectomy stress urinary incontinence, or those who underwent a revision procedure, 133 patients remained. 104 of these had their drain removed on postoperative day three. Of these, drain output data was available for 37 patients. Drain output volumes were evaluated based on surgical approach and compared using a one-way ANOVA statistical analysis. Results Granular drain output data was available for 37 patients. 8 of these patients underwent IPP placement by infrapubic approach, 13 underwent IPP placement by penoscrotal approach, and 16 patients underwent IPP placement by subcoronal approach. Patients who underwent infrapubic IPP placement trended towards increased drain output compared to those who underwent placement via a penoscrotal or subcoronal approach. These observations did not achieve statistical significance. At 72 hours post-op, drain output among all three groups was comparably low. Conclusions As previously demonstrated, an extended post-operative drain duration of three days is not associated with an increased risk of infection in patients undergoing IPP implant. Especially in patients undergoing IPP placement via infrapubic approach, drain output was significant until approximately 72 hours post-op. This data supports the utility in keeping a post-surgical drain for three days in order to maximize drainage and minimize postoperative discomfort. Given the low volume output across all three groups at 72 hours post-op, post-surgical drainage for greater than 3 days is not likely to provide additional benefit. Disclosure No

Acute Issues of Lactation Mastitis Therapy

Introduction. Lactation mastitis can complicate the course of the postpartum period in every tenth case. Under lactation abscess, the tactic of performing wide incisions to drain the breast abscess and complete lactation by medications is common. International studies report that the treatment of lactational purulent mastitis complicated by an abscess is possible in a minimally invasive way - by puncture or drainage of an abscess under ultrasound navigation. The current trend in the treatment of lactational breast abscess also includes preservation of breastfeeding.The aim of the study was to develop a modern approach to the complex treatment of purulent lactation mastitis.Materials and methods. We treated 64 breast abscesses that were complications of lactation mastitis with minimally invasive methods in 2018-2020. Most of the patients preserved lactation.Results and discussion. The average age of patients was 24.9 years. In the first group of patients (puncture techniques for treating abscesses), the diameter was 24 mm on average, in the second group (drainage technique for treating abscesses) the diameter was 53 mm on average. All procedures were performed under local anesthesia. The average score of the severity of pain syndrome was 4.4 points on the day of surgery. The average duration of drainage was 4.4 days. None of patients had a relapse of the disease or formation of a chronic fistula within 2 months followed by the operation. No negative evaluation of satisfaction with the cosmetic result was received. Breastfeeding continued in 78-87.5% of patients after surgery.Conclusion. Minimally invasive surgical techniques in the treatment of breast abscesses (punctures and drainage under ultrasound navigation) are the operations of choice. The optimal treatment of lactation mastitis complicated by a breast abscess, in addition to surgical treatment, includes effective expression of breast milk, administration of antibacterial drugs, non-steroidal anti-inflammatory drugs, and preservation of breastfeeding.

Early post-operative benefits of a pulmonary valve-sparing strategy during Fallot repair

BackgroundPatients undergoing complete repair of tetralogy of Fallot generally have an excellent prognosis. Unfortunately, pulmonary valve reconstruction with a transannular patch is generally required. Resulting pulmonary regurgitation is associated with late right ventricular dysfunction and morbidity. Early pulmonary regurgitation may also be poorly tolerated. This study compares immediate outcomes of non-valved transannular patch repair (NV-TAP) to a valve-sparing (V-Sp) approach. Methods67 patients, with tetralogy of Fallot and severe pulmonary annular hypoplasia underwent complete repair between 2010 and 2018.23 patients had a NV-TAP repair while a V-Sp technique was used in 44 patients. Mortality, length of stay in the intensive care unit and hospital, use of inotropes, duration of mechanical ventilation, use and duration of dialysis, chest drainage duration, reinterventions, and postoperative complications were compared. Immediate outcomes were assessed by biological data and postoperative echocardiography. ResultsICU stay was shorter in the V-Sp group (5 days vs 8 days, p = 0.009). At postoperative day 1, Vasoactive Inotropic Score and mean dosage of adrenaline were significantly lower in the V-Sp group. Duration of inotrope use was significantly shorter. Hospital stay, mechanical ventilation, and chest drainage duration, the incidence and duration of dialysis all showed a trend towards being lower in the V-Sp group. Surgical complications were similar despite longer cardiopulmonary bypass and aortic cross-clamp durations. ConclusionRepair of the native pulmonary valve by a V-Sp technique reduces length of stay in the ICU and the use of inotropic agents in the immediate post-operative period.

Management of residual spaces after lung resections and air leaks: Ultrasound and pneumoperitoneum.

Prolonged chest tube drainage is one of the most common postoperative complications of pulmonary resections; it is related to complications such as residual pleural spaces or continuous alveolar air leaks. We retrospectively evaluated the efficacy of artificial intraoperative pneumoperitoneum in the treatment of such complications after lung resections. The presence of a residual space associated with prolonged air leaks can be difficult to treat, exposes the patient to a high risk of infection, prolongs hospitalization, and in some cases mandates reoperation. Between October 2016 and March 2020, four patients underwent pneumoperitoneum. The obliteration of the pleural cavity and the absence of air leaks were observed in 3 patients; only 1 patient was discharged with a Heimlich valve. Artificial intraoperative pneumoperitoneum is a safe and simple procedure. It decreases the duration of chest drainage and of the hospital stay; however, further studies are needed to corroborate our data. The learning curve for this technique may be relatively short.

Predictors of outcome of chest tube drainage of nonpurulent exudative pleural effusions

BackgroundAlthough chest tube drainage is the primary management method for many pleural effusions, it has a failure rate of 9.4–48%. In this study, we examined the factors that predict the outcome of management of nonpurulent exudative effusions. The aim of this study was to determine the predictors of outcomes of chest tube drainage of pleural effusions.MethodologyConsecutive patients who had a chest tube drainage of nonpurulent exudative pleural effusions were followed up in a prospective observational cohort study until extubation and discharge. Data on the management of the patients were recorded, analysed and compared between groups of patients with good and poor outcomes.ResultsOf the 52 patients studied, 38 had good outcomes, while 14 had poor outcomes. The mean±sd age was 39.7±15.9 years. Multivariate analysis demonstrated that empyema thoracis complicating drainage was an independent predictor of a poor outcome, while the duration of drainage ≤14 days and duration of illness before presentation <30 days were predictive of a good outcome.ConclusionOur results show that the development of empyema thoracis during drainage, a long duration of drainage and a prolonged period of illness before presentation are predictive of the outcome of chest tube drainage.