Early Operative Outcome Research Articles

Paediatric Neurosurgical emergency operations:Clinical spectrum, Presentation-Intervention Interval and Early operative outcome in Regional Neurosurgical center, Nigeria

BACKGROUND: Pediatric neurosurgical emergencies are prevalent worldwide, often triggered by acute, life-threatening conditions that necessitate immediate surgery to prevent disability and death. Managing these conditions perioperatively poses significant challenges for neurosurgeons and anesthetists due to potential complications like anemia, seizures, electrolyte imbalances, intracranial hypertension, and vision threats, alongside the primary neurosurgical issues. Proper correction and optimization of these physiological derangements before surgery are crucial for favorable postoperative outcomes. PATIENTS AND METHODS: This retrospective study analyzes emergency neurosurgical operations performed on children aged sixteen and under at a neurosurgical center in Sokoto, Nigeria, from January 2018 to December 2021. The center caters to a population of approximately twenty million people from three north-western and one north-central Nigerian states, as well as neighboring Niger and Benin republics. The area features a mostly arid climate with limited seasonal rainfall and experiences the Sahara’s harmattan winds. RESULTS A total of 131 children underwent emergency neurosurgical procedures during the study period. The majority were males (71%), with an average age of 5.6 years. Hydrocephalus was the most frequent emergency condition, leading to 44.3% of surgeries, primarily through ventriculoperitoneal shunt procedures, which accounted for 42.7% of interventions. Anemia was the most common comorbid condition. The mean time from presentation to intervention was 10 days. Postoperatively, 17.9% of patients suffered from surgical site infections, yet 67.9% had favorable outcomes with a mortality rate of 7.1%. CONCLUSION: This study underscores the importance of timely surgical interventions and highlights the predominance of ventriculoperitoneal shunts in treating pediatric hydrocephalus in the region, with generally positive outcomes despite delays

Clinical outcome of right ventricle outflow tract management for repair of Tetralogy of Fallot with three contemporary surgical strategies.

Objective:To compare the early operative outcome of TOF repair with three contemporary repair strategies of RVOTO repair i.e. TAP, Mono-cusp construction (MC) in TAP and pulmonary valve repair.Methods:Study is performed at Punjab Institute of Cardiology, Lahore from May 2016 to April 2020. Retrospective analysis of data was performed for patient who underwent TOF repair by three different strategies of RVOT repairs during TOF surgery based on z scoring for pulmonary valve annulus. Group-I underwent trans-annular patch repair, while Group-II and III underwent Mono-cusp repair with autologous pericardium and pulmonary valve repair respectively. Analysis of Variance (ANOVA) and Pearson Chi-Square (PCS) statistics were used to compare the three groups for numeric and categorical variables respectively. Post-hoc t-test and Bonferroni correction were performed for numeric data to compare two groups with each other. Chi-square test was used to perform comparison between groups for categorial variables.Results:ANOVA for aortic cross clamp time, total CPB time, Post-operative mechanical ventilation time, ICU stay and hospital stay showed statistical difference among all three group with p-value less than 0.05 however post hoc T-test showed this variation is limited to post-operative mechanical ventilation only when groups compared with each other. PCS showed there was difference for incidence of difficult weaning from CPB when all three groups compared while there was no difference in operative mortality with p-value of 0.15. However, Group-II comparison with Group-I showed that weaning from CPB was superior in-Group-II with p-value of 0.016. Group-III showed the best statistics for all operative outcome variables among all three groups. Comparison of incidence of post-operative moderate pulmonary regurgitation before discharge between Group-II and Group-III showed significant difference with p-value of 0.0052.Conclusion:PV repair strategy should be employed for RVOT repair of TOF whenever feasible. MC repair showed fewer hours of postoperative mechanical ventilation and higher incidence of easy weaning from CPB when compared to TAP, however its impacts over ICU stay, Hospital stay and operative mortality is not profound in our TOF repair population.

The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients.

Objective:To document our experience of the primary anterior sagittal anorectoplasty (ASARP) in female patients with lower and wide fistula in term of the early post operative outcome.Methods:A retrospective descriptive study was conducted in one surgical unit of the National Institute of Child Health Karachi, from January 2010 to April 2018. The study included female patients with diagnosis of imperforate anus with wide Vestibular or Perineal fistula with minimal or no straining during defecation and no excoriation of perineum. All patients underwent primaryASARP. Data regarding the age of the patients, site of fistula, the difficulties in dissection, post operative complications, stoma and re-do ASARP needed, were documented. Wound assessment was done during hospital stay, at two weeks and then at three months after surgery. Outcome was documented in terms of complications of surgery and cosmetic appearance of perineum. Data was analyzed on SPSS version 20.Results:A total of 70 patients underwent primary surgery, 48(68.57%) females had perineal fistula while 22(31.42%) had vestibular fistula. Age ranges between three months to 276 months with median of 6±39.73 months. No major injury to the rectal or vaginal wall occurred during surgical procedure. In early post-operative period, 12(17.14%) patients had wound infection with or without various extent of disruption. A total of seven (10.11%) patients underwent stoma formation, six (8.57%) patients because of wound disruption with in a week of primary surgery and in one patient due to severe anal stenosis and retraction of anal segment within three month follow up. Median hospital stay was 5±1.52 days. In 38(54.28%) paients complete wound healing occurred with no per or post operative complications. In 25(35.71%) patients, minor complications were noted and treated accordingly and results were labelled satisfactory with acceptable perineal appearance.Conclusion:The single stage procedure can be a good choice for both vestibular and perineal fisula. In majority of cases wound heals completely with minimal or no scaring and give good cosmetic results.

Early operative outcome of pericardiectomy for symptomatic chronic tuberculous constrictive pericarditis

Background: Pericardiectomy procedure is commonly indicated for constrictive pericarditis (CP). One of the most important clue to diagnosis of CP is the signs and symptoms of right-sided heart failure that are not completely explained by presence of pulmonary disease or left-ventricular failure. The aim of this study was to assess clinical data presentation and early operative outcomes of pericardiectomy performed for symptomatic chronic constrictive pericarditis who had failed maximal medical therapy.
 Methodology: A retrospective analysis was carried out of consecutive constrictive pericarditis adult age patients who underwent pericardiectomy procedure from 2002 to 2012. The patients who had intraoperative diagnosis of other then constrictive pericarditis were excluded from further analysis. A total 51 patients were selected for this study. The preoperative assessment, intraoperative findings and postoperative course and outcome such as hospital stay, prolonge ICU stay, post-operative CPV etc. were evaluated.
 Results: 43 males and 8 females were include in the study among them 41% gave history of previous (TB) and 35% were pediatric patients (teens, as shown less than 19 years). 8 patients had effusive type pericarditis. The preoperative findings revealed dyspnea 54%, Chest Pain 45% and persistent cough 31%. Furthermore, 43% patients had ascites and 41% with pleural effusion. The mean preoperative central venous pressure (CVP) was 20.5 respectively. The post-operative outcome was short hospital stay, the post-operative patients CVP was estimated 13.5 and the mean drop of CVP due to pericardiectomy was estimated 7 respectively.
 Conclusion: The conclusive findings of our study revealed that among the patients of symptomatic chronic tuberculous CP, the timely pericardiectomy attempt can effectively improve the hemodynamics of the patient. The early pericardiectomy can also reduce the morbidity and mortality rate of these patients.

Preoperative albumin as a predictor of early post operative outcome in patients undergoing radical cholecystectomy for carcinoma of gall bladder.

Preoperative albumin as a predictor of early post operative outcome in patients undergoing radical cholecystectomy for carcinoma of gall bladder.

Hyperbilirubinemia after cardiac surgery: An observational study.

We aimed to assess the incidence and perioperative risk factors for hyperbilirubinemia after cardiac surgery, and determine its influence on early operative outcome. This prospective observational study was conducted on 476 patients who underwent cardiac surgical procedures from January 2014 to March 2014. Postoperative hyperbilirubinemia was defined as serum total bilirubin >2.0 mg dL(-1). The overall incidence of postoperative hyperbilirubinemia was 25% (119 patients). Patients undergoing valve repair or replacement had the highest incidence of hyperbilirubinemia (36.2%), followed by coronary artery bypass grafting with concomitant valve surgery (34.1%), congenital heart surgery (23.1%), and coronary artery bypass alone (12.7%). Postoperative hyperbilirubinemia was associated with increased duration of inotropic support (p = 0.0001), mechanical ventilation (p = 0.0001), intensive care unit stay (p = 0.001), hospital stay (p = 0.006), and mortality (p = 0.014). The perioperative factors associated with postoperative hyperbilirubinemia were increased preoperative bilirubin level (p < 0.0001), preoperative prothrombin time (p < 0.0001), cardiopulmonary bypass time (p = 0.028), aortic crossclamp time (p = 0.004), and blood transfusion units (p = 0.0001). Postoperative hyperbilirubinemia is common in patients undergoing cardiopulmonary bypass and is associated with high hospital mortality. The factors associated with its occurrence are increased preoperative bilirubin level, preoperative prothrombin time, cardiopulmonary bypass time, aortic crossclamp time, and blood transfusion units. Persistent hyperbilirubinemia is associated with a worse outcome than early transient hyperbilirubinemia.

Beneficial effect of intra-operative methylprednisolone on immediate post liver transplant intensive care course.

Concern about the effect of corticosteroids on outcomes following liver transplantation (LT), especially in recipients with hepatitis C infection (HCV) has lead many centres to abandon the use of perioperative steroids. Avoidance of corticosteroids in immunosuppressive regimens may have beneficial effects in terms of reducing the incidence of infection, new onset diabetes mellitus and HCV recurrence however perioperative use may have beneficial effects such as attenuation of ischaemia-reperfusion injury (IR) and treatment of underlying adrenal insufficiency (AI). Due to a high prevalence of adrenal insufficiency in patients on our waiting list for LT, we reintroduced the use of intraoperative methyl-prednisolone and hypothesised that this would improve early post operative outcome. 90 consecutive patients were studied, 45 before (group 1) and 45 (group 2) after the protocolised reintroduction of methylprednisolone (1g IV) intraoperatively prior to reperfusion. Peri- and post-transplant requirements for colloid, crystalloid, blood products, vasopressors, renal replacement therapy and ventilation were compared between groups. No other changes to the transplant protocol occurred during the study period. Patients who received intraoperative methlyprednisolone had significantly shorter post operative ITU stay, vasopressor and colloid requirement post LT, and were dependent on mechanical ventilation for less time. These data suggest that the use of intraoperative methylprednisolone can modify the immediate post transplant course of LT, either by attenuating reperfusion induced inflammation, or by addressing hitherto unrecognized adrenal insufficiency.

MP60-13 PSOAS MUSCLE MASS AS A PREDICTOR OF SURVIVAL IN PATIENTS WHO UNDERGO RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2014MP60-13 PSOAS MUSCLE MASS AS A PREDICTOR OF SURVIVAL IN PATIENTS WHO UNDERGO RADICAL CYSTECTOMY Hamed Ahmadi, Michael Terjimanian, Anna Sadie Chernin, Stephanie Daignault-Newton, Neal All-Attar, Stephen Dailey, Jeffery Montgomery, Alon Z. Weizer, James E. Montie, and Cheryl T. Lee Hamed AhmadiHamed Ahmadi More articles by this author , Michael TerjimanianMichael Terjimanian More articles by this author , Anna Sadie CherninAnna Sadie Chernin More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Neal All-AttarNeal All-Attar More articles by this author , Stephen DaileyStephen Dailey More articles by this author , Jeffery MontgomeryJeffery Montgomery More articles by this author , Alon Z. WeizerAlon Z. Weizer More articles by this author , James E. MontieJames E. Montie More articles by this author , and Cheryl T. LeeCheryl T. Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1767AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Morphomic measures of abdominal muscle mass, as physical component of frailty evaluation, are reportedly accurate predictors of early and late operative outcome in patients who undergo major abdominal surgeries. We evaluated the association between CT scan-based psoas muscle mass area and operative outcome of radical cystectomy (RC) and urinary diversion reconstruction. Methods In a retrospective single center study, 442 bladder cancer patients who underwent RC and urinary diversion reconstruction at Department of Urology, University of Michigan between 2007 and 2012 were enrolled. Cross-sectional areas of the left and right psoas muscles at the level of L4 were determined and summed to generate the total cross sectional area of the psoas muscles (TPA). Outcome measures of interest were short-term outcome including length of hospital stay (LOS), 30-day readmission rate (RR) and complication rate (CR); Intermediate-term outcome including 90-day RR and CR as well as 6-month mortality; and long-term outcome including 3-yr overall survival (OS). Multivariate logistic and Cox proportional-hazards regression models were used to determine predictors of operative outcome and OS, respectively. Predictive accuracy of different survival models were also compared using Receiver Operating Characteristic (ROC) curves. Results Mean age of participants and follow up time was 66 y/o (range, 31 – 91) and 2.3 yrs (range, 0.04 – 6.3), respectively. Mean TPA was 2363 mm2 (range, 552 – 4322). Mean LOS was 10 days. 30-day RR and CR were 63/466 (13.5%) and 196/440 (44.5%), respectively. TPA was not associated with any early operative outcome measures. (P>0.05) 90-day RR and CR were 95/466 (20%) and 238/466 (51%), respectively. Thirty patients (6.4%) died within first 6-months from surgery of whom, 21 (70%) died of UCB. TPA was not associated with any intermediate operative outcome measures. (P>0.05) 3-year OS rate was 0.62 (range, 0.56–0.67). TPA (HR= 0.96, 95%CI: 0.93 – 0.98; P= 0.005) was significantly associated with 3-year OS. Patients with TPA at highest quartile had 0.18 survival advantage over those with TPA at lowest quartile 3 years from RC. (P= 0.02) Predictive accuracy of 3-year survival model composed of pathologic stage, age, and comorbidity was increased from 0.74 to 0.80 when TPA was included in the model. Conclusions Muscle mass does not seem to be an independent predictor of early morbidity and mortality following RC. However, it is an independent predictor of long term survival, regardless of age, pathologic stage, and comorbidities. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e637 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Hamed Ahmadi More articles by this author Michael Terjimanian More articles by this author Anna Sadie Chernin More articles by this author Stephanie Daignault-Newton More articles by this author Neal All-Attar More articles by this author Stephen Dailey More articles by this author Jeffery Montgomery More articles by this author Alon Z. Weizer More articles by this author James E. Montie More articles by this author Cheryl T. Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery

Background and aimChylothorax is the accumulation of chyle in the pleural cavity, which usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases, this rupture is secondary to trauma (including cardio thoracic surgeries). Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management. This study aims to determine the risk factors and the impact of chylothorax on the early postoperative course after pediatric cardiac surgery. MethodsA retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery was conducted at King Abdulaziz Cardiac Center between January 2007 and December 2009. ResultsThere were 1135 cases operated on during the study period. Of these, 57 cases (5%) were complicated by chylothorax in the postoperative period. Thirty patients (54%) were males, while 27 (47%) were females. Ages ranged from 4 to 2759days. The most common surgeries complicated by chylothorax were the single ventricle repair surgeries (15 cases, 27%); arch repairs (10 cases, 18%); ventricular septal defect repairs (10 cases, 18%); atrioventricular septal defect repairs (7 cases, 12%); arterial switch repair (6 cases, 11%), and others (8 cases, 14%). The intensive care unit (ICU) and the length of hospital stays were significantly longer in the chylothorax group. Additionally, some early postoperative parameters such as incidence of sepsis, ventilation time, and inotropes duration and number were higher in the chylothorax group. ConclusionChylothorax after pediatric cardiac surgery is not a rare complication. It occurs more commonly with single ventricle repair and aortic arch repair surgeries, and has a significant impact on the postoperative course and post operative morbidity.

Effect of pre-fracture mobility on the early post-operative functional outcome in elderly patients with a hip fracture

Background: Hip fractures are among the most commoncauses of disability and hospitalisation in the elderly. There are no studies inSouth Africa that determine the effect of pre-fracture functional mobility onearly post-operative functional outcome in elderly patients with a hip fracture.Aim: The aim of this study was to determine the effect of pre-fracture functionalmobility on early post-operative functional outcome in elderly patients with ahip fracture.Methodology: A prospective pre-test post-test observational study designwas done. Assessments were conducted pre-operatively, at discharge and sixweeks post discharge at two public hospitals in Johannesburg, South Africa. Thepre-fracture functional mobility of the participants was determined using theNew Mobility Score (NMS) pre-operatively. At discharge and at six weeks post discharge the participants post-operative functionallevel was assessed using the Elderly Mobility Scale (EMS) and the Lower Extremity Functional Scale (LEFS).Results: More than two thirds of participants were independently mobile prior to the fracture. Pre-fracture functional mobilityis a strong determinant of early post operative functional outcome in elderly patients with a hip fracture(β = 1.39, p = 0.0001).Conclusion: Independent pre-fracture mobility predicts better early post-operative functional outcomes in the elderly.

SHA 075. Congenital heart disease in thoraco-omphalopagus conjoined twins

Northwest Armed Forces Hospital Tabuk, Saudi Arabia We present a case of right sided diphragmatic hernia in a three years old girl.The child had a Ventricular Septal defect (VSD) closure via median sternotomy one year ago. The child also had a permanent pacemaker implanted for heart block after VSD closure on bypass. She presented one year later with some shortness of breath. Chest X-ray at that stage was interpreted as ‘‘eventeration’’ of left Hemidiaphragm. In the subsequent months she was readmitted with respiratory symptoms.Herniation of gut loops in left pleural cavity were confirmed on X-rays, and CT with Contrast. The child under went successful repair of the diaphragmatic hernia via laparotomy. Review of literature showed two previous case reports of Iatrogenic Diaphragmatic Hernia in children after cardiac operations via median sternotomy. Conclusion: diaphragmatic hernia should be kept in mind while interpreting unusual looking chest xrays in children atier open heart surgery. doi:10.1016/j.jsha.2011.02.077 SHA 077. Effect of age of repair of Tetralogy of Fallot on the short term outcome Sameh Rabie Ismail, Mohamed S. Kabbani, MD, Hani K. Najm, MD, Riyadh M. Abu-sulaiman Department of Cardiac Sciences (MC: 1420), King Abdulaziz Medical City, National Guard Hospital, P.O. Box 22490, Riyadh 11426, Saudi Arabia E-mail address: samis93@gmail.com (S.R. Ismail) Introduction: All patients with Tetralogy of Fallot (TOF) require surgical intervension. Significant advances in the perioperative care, anaesthesia, and cardiopulmonary bypass techniques have spurred earlier correction. Aim of the study: To study the effect of age of repair on the early post operative course and outcome of children undergoing TOF repair. Method: A retrospective study of all cases of TOF repair in King Abdulaziz Cardiac Center between March 2002 and December 2007 was conducted. We excluded cases with pulmonary atresia and neonatal repair. Cases were divided into three groups. Group A included cases operated at the age below 6 months, group B included cases operated between 6 and 12 months, while group C included cases operated above 12 months. We compared demographic, risk category, ICU parameters, ECHO data and short-term outcome of both groups. Results: 83 patients fulfilled the study criteria. We identified 24 Cases (29%) in-group A, 32 cases (39%) in group B,and 27 cases (33%) in group C. There was a tendency toward having a smoother course post operatively in the group B which was operated between 6 and 12 months, but We did not appreciate any statistically significant effect for age on the early post operative outcome of Tetralogy of Fallot repair. Conclusion: In general, children undergoing TOF repair had excellent short-term outcome. Contrary to some previous reports, in our series of TOF repair there was no effect for the age of repair on the early post operative outcome. doi:10.1016/j.jsha.2011.02.078 SHA 078. Chylothorax after pediatric cardiovascular surgery Sameh Rabie Ismail, Mohamed S. Kabbani, MD, Hani K. Najm, MD, Ghassan A. Shaath, MD, Abdulraouf M.Z. Jijeh, MD National Guard Hospital, Cardiac Intensive Care, Riyadh, Saudi Arabia E-mail address: samis93@gmail.com (S.R. Ismail) Background: Chylothorax is the accumulation of chyle in the pleural cavity, usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases this rupture is secondary to trauma (including cardio thoracic surgeries). Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management. Methods: A retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery in King Abdulaziz Cardiac Center between January 2007 and December 2009 was conducted. Chylothorax was certainly suspected if milky fluid drainage from the pleura in the post-operative period, it is also suspected if excessive drainage of non-milky fluid, and in all cases the diagnosis was confirmed by laboratory analysis of the pleural fluid. The study aim to determine the risk factors, the impact on Abstract for SHA22 193

SHA 076. Iatrogenic diaphragmatic hernia one year after VSD closure in a child

Northwest Armed Forces Hospital Tabuk, Saudi Arabia We present a case of right sided diphragmatic hernia in a three years old girl.The child had a Ventricular Septal defect (VSD) closure via median sternotomy one year ago. The child also had a permanent pacemaker implanted for heart block after VSD closure on bypass. She presented one year later with some shortness of breath. Chest X-ray at that stage was interpreted as ‘‘eventeration’’ of left Hemidiaphragm. In the subsequent months she was readmitted with respiratory symptoms.Herniation of gut loops in left pleural cavity were confirmed on X-rays, and CT with Contrast. The child under went successful repair of the diaphragmatic hernia via laparotomy. Review of literature showed two previous case reports of Iatrogenic Diaphragmatic Hernia in children after cardiac operations via median sternotomy. Conclusion: diaphragmatic hernia should be kept in mind while interpreting unusual looking chest xrays in children atier open heart surgery. doi:10.1016/j.jsha.2011.02.077 SHA 077. Effect of age of repair of Tetralogy of Fallot on the short term outcome Sameh Rabie Ismail, Mohamed S. Kabbani, MD, Hani K. Najm, MD, Riyadh M. Abu-sulaiman Department of Cardiac Sciences (MC: 1420), King Abdulaziz Medical City, National Guard Hospital, P.O. Box 22490, Riyadh 11426, Saudi Arabia E-mail address: samis93@gmail.com (S.R. Ismail) Introduction: All patients with Tetralogy of Fallot (TOF) require surgical intervension. Significant advances in the perioperative care, anaesthesia, and cardiopulmonary bypass techniques have spurred earlier correction. Aim of the study: To study the effect of age of repair on the early post operative course and outcome of children undergoing TOF repair. Method: A retrospective study of all cases of TOF repair in King Abdulaziz Cardiac Center between March 2002 and December 2007 was conducted. We excluded cases with pulmonary atresia and neonatal repair. Cases were divided into three groups. Group A included cases operated at the age below 6 months, group B included cases operated between 6 and 12 months, while group C included cases operated above 12 months. We compared demographic, risk category, ICU parameters, ECHO data and short-term outcome of both groups. Results: 83 patients fulfilled the study criteria. We identified 24 Cases (29%) in-group A, 32 cases (39%) in group B,and 27 cases (33%) in group C. There was a tendency toward having a smoother course post operatively in the group B which was operated between 6 and 12 months, but We did not appreciate any statistically significant effect for age on the early post operative outcome of Tetralogy of Fallot repair. Conclusion: In general, children undergoing TOF repair had excellent short-term outcome. Contrary to some previous reports, in our series of TOF repair there was no effect for the age of repair on the early post operative outcome. doi:10.1016/j.jsha.2011.02.078 SHA 078. Chylothorax after pediatric cardiovascular surgery Sameh Rabie Ismail, Mohamed S. Kabbani, MD, Hani K. Najm, MD, Ghassan A. Shaath, MD, Abdulraouf M.Z. Jijeh, MD National Guard Hospital, Cardiac Intensive Care, Riyadh, Saudi Arabia E-mail address: samis93@gmail.com (S.R. Ismail) Background: Chylothorax is the accumulation of chyle in the pleural cavity, usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases this rupture is secondary to trauma (including cardio thoracic surgeries). Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management. Methods: A retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery in King Abdulaziz Cardiac Center between January 2007 and December 2009 was conducted. Chylothorax was certainly suspected if milky fluid drainage from the pleura in the post-operative period, it is also suspected if excessive drainage of non-milky fluid, and in all cases the diagnosis was confirmed by laboratory analysis of the pleural fluid. The study aim to determine the risk factors, the impact on Abstract for SHA22 193

Initial Experience of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients

Purpose: Laparoscopic sleeve gastrectomy (LSG) is rapidly gaining ground as one of the surgical procedures in bariatric surgery with emerging long-term follow-up data. The aim of the present study was to report our initial experience of LSG in morbidly obese patients. Methods: Sixty-four consecutive patients underwent LSG from April 2009 to July 2010 at our bariatric surgery center. Patients eligible for LSG were those with a body mass index (BMI) of ＞37 ㎏/㎡, and ＞32 ㎏/㎡ with co-morbidities. LSG was performed using 5 trocars and endo-staplers with guidance of 34 Fr bougie. Perioperative management was standardized. The clinical data were prospectively collected and retrospectively analyzed. Results: Among 64 patients, 19 were male and 45 were female, mean age was 35 years (range 20∼57), mean preoperative BMI was 38.8 ㎏/㎡ (range 32∼57), and mean preoperative body weight was 108 ㎏ (range 75∼164). Mean operative time was 118 minutes (range 65∼340) and mean length of hospital stay was 3.4 days (range 1∼82). Staple line leak occurred in 1 patient, kinking of the gastric tube occurred in 2 patients. There was no open conversion and no postoperative mortality. After 170 days of follow-up, 24.4 ㎏ of body weight loss and 52.7% of excess weight loss (%EWL), on average, was noted. Conclusion: Though long-term follow-up is needed, our early operative outcome was satisfactory in terms of %EWL and safety of the procedure. LSG was a safe and effective treatment strategy for morbidly obese patients.

Cardiac Anesthesia and Surgery in Geriatric Patients

The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention. Advanced age is associated with decreased physiologic reserve and significant comorbidity. Thorough preoperative assessment, identification of the risk factors for perioperative morbidity and mortality, and optimal preparation are critical in these patients. Age-related changes in comorbidities and altered pharmacokinetics and pharmacodynamics impacts anesthetic management, perioperative monitoring, postoperative care, and outcome. This article updates the age-related changes in organ subsystems relevant to cardiac anesthesia, perioperative issues, and intraoperative management. Early and late operative outcome in octogenarians undergoing cardiac surgery are reviewed. The data clearly indicate that no patient group is "too old" for cardiac surgery and that excellent outcomes can be achieved in selected group of elderly patients.