Effect Of Surgical Approach Research Articles

The Influence of Surgical Factors on Persisting Symptoms 3 Years after Esophageal Cancer Surgery: A Population-Based Study in Sweden

Little is known about the long-term effects of surgical approach and type of anastomosis in the surgical treatment of esophageal cancer on patient-reported outcomes. A Swedish nationwide, population-based cohort study included patients undergoing esophagectomy for esophageal cancer in 2001-2005. The predefined exposures included surgical approach (transhiatal or transthoracic) and anastomotic technique (hand-sewn or mechanical). The outcomes were esophageal-specific symptoms 3 years after the surgery. Symptoms were measured using the cancer-specific quality of life questionnaire, the QLQ-C30, supplemented by an esophageal cancer-specific module (QLQ-OES18), both developed by the European Organisation for Research and Treatment of Cancer. Logistic regression models were used to estimate relative risk, expressed as odds ratios (OR) with 95 % confidence intervals (CI), of experiencing symptoms as assessed by the questionnaires. Among the 178 included patients, there was an 84 % participation rate. No statistically significant differences were found regarding surgical approach. However, point estimates indicate that patients operated on with a transhiatal approach had a lower risk for symptoms of nausea and vomiting (OR = 0.5, 95 % CI 0.1-1.9), diarrhea (OR = 0.5, 95 % CI 0.2-1.8), and trouble swallowing (OR = 0.4, 95 % CI 0-3), and a slightly higher risk for loss of appetite (OR = 2, 95 % CI 0.7-5.6) compared with patients operated on with a transthoracic approach. Anastomotic technique did not seem to influence the risk for any of the selected symptoms. Surgical approach and type of anastomosis do not seem to influence the risk of general and esophageal-specific cancer symptoms 3 years after surgery for esophageal cancer.

The effect of surgical approach on tibial nail position – Standard versus semi-extended – Preliminary results of a randomised controlled trial

The effect of surgical approach on tibial nail position – Standard versus semi-extended – Preliminary results of a randomised controlled trial

Effect of Surgical Approach on 30-Day Mortality and Morbidity After Elective Colectomy: a NSQIP Study

PurposeThe aim of this study was to evaluate the laparoscopic approach and pre- and postoperative conditions as predictors of 30-day mortality and morbidity in elective colectomy. MethodsElective colectomies were identified in the 2005–2008 American College of Surgeons National Surgical Quality Improvement Program database. Multivariate logistic regression was used to model 30-day mortality and morbidity following elective colectomy. Propensity scores were calculated to decrease selection bias. ResultsDuring the period studied, 14,321 patients underwent open colectomy and 10,409 underwent laparoscopic colectomy. Factors that significantly influenced mortality included male gender [odds ratio (OR) 1.4, confidence interval (CI) 1.07–1.9]; age (OR 1.07, CI 1.05–1.08); comorbidities including dyspnea, ascites, congestive heart failure, dialysis, or disseminated cancer; and postoperative conditions including reintubation (OR 2.6, CI 1.6–4.0), renal failure (OR 3.8, CI 2.1–6.9), stroke (OR 6.44, CI 2.4–17.6), and septic shock (OR 13.1, CI 8.76–19.4). While laparoscopy was not independently associated with mortality, it was associated with decreased postoperative morbidity including reintubation (OR 0.74, CI 0.59–0.91), renal failure (OR 0.60, CI 0.4–0.91), septic shock (OR 0.74, CI 0.59–0.92), wound infection (OR 0.58, CI0.44–0.77), and pneumonia (OR 0.71, CI 0.59–0.86). ConclusionsBased on this analysis, laparoscopy was associated with a decrease in 30-day postoperative morbidity for colectomy. However, after adjusting for preoperative comorbidities and postoperative morbidities, laparoscopy did not independently influence mortality after colectomy.

Effect of surgical approach on physical activity and pain control after sacral colpopexy

We sought to compare recovery of activity and pain control after robotic (ROB) vs abdominal (ABD) sacral colpopexy. Women undergoing ROB and ABD sacral colpopexy wore accelerometers for 7 days preoperatively and the first 10 days postoperatively. They completed postoperative pain diaries and Short Form-36 questionnaires before and after surgery. At 5 days postoperatively, none of the 14 subjects in the ABD group and 4 of 28 (14.3%) in the ROB group achieved 50% total baseline activity counts (P = .283). At 10 days, 5 of 14 (35.7%) in the ABD group and 8 of 26 (30.8%) in the ROB group (P = .972) achieved 50%. Postoperative pain was similar in both groups. Short Form-36 vitality scores were lower (P = .017) after surgery in the ABD group, but not in the ROB group. Women undergoing ROB vs ABD sacral colpopexy do not recover physical activity faster, and pain control is not improved.

Effect of surgical approach on physical activity and pain control after sacral colpopexy

Effect of surgical approach on physical activity and pain control after sacral colpopexy

Effects of four different surgical approaches on intra-operative joint gap in posterior-stabilized total knee arthroplasty

The effects of surgical approaches and patellar positions on joint gap measurement during total knee arthroplasty (TKA) remain unclear. We hypothesized that joint gap changes with different knee flexion angles would not be consistent within four different approaches and two different patellar positions. This study enrolled 80 knees undergoing posterior-stabilized TKA. For 60 varus knees, parapatellar, midvastus, and subvastus approaches were used in 20 knees each. For 20 valgus knees, a lateral subvastus approach was used. Component gap length and inclination were measured intra-operatively using a specific tensor device under 40 lb with the patella reduced or shifted laterally, at 0°, 45°, 90°, and 135° of knee flexion. Mean gap lengths at 45° and 90° of knee flexion were significantly larger with the parapatellar approach than with midvastus or lateral subvastus approaches (P < 0.05). Regarding gap inclination, varus angle increased linearly through the entire arc of flexion in all four approaches. When the patella was shifted laterally, gap lengths at 45°, 90°, and 135° were significantly reduced compared with those for the patella reduced in the subvastus approach, whereas gap length was constant in the parapatellar approach, regardless of patellar position. Joint gap kinematics was not consistent within four different approaches and two different patellar positions. Relatively large gaps at 45° and 90° were unique features for the parapatellar approach. Surgeons should be aware that the flexion gap is reduced when the patella is shifted laterally in vastus medialis-preserving approaches such as the subvastus approach. II.

Effects of surgical approach on functional outcomes of open reduction and internal fixation of intra-articular distal humeral fractures: a systematic review

Fractures of the distal humerus are uncommon injuries, constituting between 0.5% and 7% of all fractures and 30% of all elbow fractures. Up to 96% of these injuries are intercondylar, or AO type C, distal humeral fractures involving the articular surface. These fractures are notoriously difficult to treat, presenting the surgeon with multiple challenges including the complex anatomy of the elbow joint itself, articular surface comminution, and frequently, osteopenic or osteoporotic bone stock. Anatomic reduction of the joint surface, restoration of the overall anatomic axes of the extremity, and stable fixation allowing for early elbow mobilization are keys to achieving a good surgical outcome. Early motion is critically important after open reduction and internal fixation (ORIF) of these fractures because the elbow joint capsule is very prone to scarring, and immobilization past 3 weeks has been linked with poorer outcomes. A number of well-described approaches are at the surgeon’s disposal for exposure of the distal humerus. These include the olecranon osteotomy, triceps-reflecting anconeus pedicle (TRAP), BryanMorrey (triceps reflecting), paratricipital (AlonsoLlames, bilaterotricipital, triceps sparing), triceps

The Effect of Surgical Approaches on Pulmonary Function in Adolescent Idiopathic Scoliosis

Retrospective study. To evaluate the effects of 4 surgical approaches for adolescent idiopathic scoliosis on pulmonary function and document their trend across a 2-year period. Understanding the effects of surgical approaches on pulmonary function is critical in the treatment of adolescent idiopathic scoliosis. Depending on the surgical approach, studies have demonstrated improvement, decline, or no effect on pulmonary function. Sixty-one patients were evaluated for vital capacity (VC) and peak flow (PF) before and following surgery at 1, 3, 6, 12, and 24 months. Patients were separated into the following groups: group 1-posterior fusion only, group 2-posterior fusion with thoracoplasty, group 3-thoracoscopic anterior fusion, group 4-open anterior thoracolumbar fusion. Between groups, no difference was found in age, preoperative curve magnitude, percent curve correction or baseline VC and PF. At 1-month postoperatively, group 3 had lower VC than group 1 (P<0.01). After 1 month, no difference was seen between groups. Compared with before surgery, group 2 demonstrated a significant decline in VC and PF at 1 month and returned to baseline at 3 months (P<0.01). Group 3 had a significant decline in VC and PF at 1, 3, and 6 months whereas group 4 had a decline in VC at 1 month (P<0.01). Scoliosis approaches that violate the chest wall demonstrate a significant decline in postoperative pulmonary function. Documented return of pulmonary function did not occur until 3 months for posterior fusion with thoracoplasty, 3 months for open anterior fusion and 1 year for video-assisted thoracoscopic surgery.

Longitudinal Assessments of Quality of Life in Endometrial Cancer Patients: Effect of Surgical Approach and Adjuvant Radiotherapy

Adjuvant radiotherapy (RT) is often considered for endometrial cancer. We studied the effect of RT and surgical treatment on patients' quality of life (QOL). All patients referred to the gynecologic oncology clinics with biopsy findings showing endometrial cancer were recruited. QOL assessments were performed using the European Organization for Research and Treatment of Cancer QOL questionnaire-C30, version 3. Assessments were obtained at study entry and at regular 3-month intervals for a maximum of 2 years. Open-ended telephone interviews were done every 6 months. Linear mixed regression models were built using QOL domain scores as dependent variables, with the predictors of surgical treatment and adjuvant RT type. A total of 40 patients were recruited; 80% of the surgeries were performed by laparotomy. Significant improvements were seen in most QOL domains with increased time from treatment. Adjuvant RT resulted in significantly more severe bowel symptoms and improvement in insomnia compared with conservative follow-up. No significant adverse effect from adjuvant RT was seen on the overall QOL. Bowel symptoms were significantly increased in patients treated with laparotomy compared with laparoscopy in the patients treated with whole pelvic RT. Qualitatively, about one-half of the patients noted improvements in their overall QOL during follow-up, with easy fatigability the most prevalent. No significant adverse effect was seen on patients' overall QOL with adjuvant pelvic RT after the recovery period. The acute adverse effects on patients' QOL significantly improved with an increasing interval from diagnosis.

Spontaneous Lumbar Curve Correction in Selective Thoracic Fusions of Idiopathic Scoliosis

A retrospective evaluation of adolescent idiopathic scoliosis (AIS) patients treated with selective thoracic instrumentation and fusion. To evaluate the predictors and the effect of surgical approach (anterior versus posterior) on spontaneous lumbar curve correction (SLCC) after selective thoracic fusion in patients with structural thoracic and compensatory lumbar curves. Spontaneous coronal correction of the unfused lumbar curve has been described previously; however controversy continues regarding the effect of surgical approach on SLCC. One hundred thirty-two anterior and 44 posterior selective thoracic fusions instrumented distally to T11, T12, or L1 were identified from a multicenter AIS database. A 2-way ANOVA was used to compare SLCC with regards to surgical approach and the lowest instrumented vertebra (LIV). A Pearson's correlation analysis was utilized to identify radiographic variables associated with SLCC. A secondary analysis of surgical approach was then performed on 28 pairs of patients matching the factors that correlated positively with SLCC. The average SLCC for the anterior approach (44% +/- 19%) was less than that for the posterior approach (49% +/- 19%; P = 0.07), and was found to increase significantly with a more distal LIV (P = 0.03). Pearson's correlation analysis revealed the strongest correlations between SLCC and preoperative lumbar curve flexibility (r = 0.20) and 2-year postoperative thoracic curve percent correction (r = 0.47). A secondary analysis of SLCC in paired curves matched by LIV, lumbar curve flexibility and thoracic percent correction revealed no difference between anterior (48%) and posterior (49%) approaches (P = 0.75). Anterior and posterior instrumented fusions performed selectively on the appropriate curves result in equal SLCC when matched by LIV, flexibility of the lumbar curve, and percent thoracic curve correction achieved. This suggests that the observed phenomenon of SLCC after selective thoracic fusion in AIS is independent of surgical approach and can be reliably achieved with either technique.

Early Hospital Discharge After 2-Incision Minimal Invasive Total Hip Arthroplasty: A Randomized, Prospective, Inpatient-Blinded Study

Reports of early hospital discharge after minimally invasive total hip arthroplasty (THA) have recently emerged and created considerable controversy. Most have confounding variables; and therefore, the effect of surgical approach on early hospital discharge after THA has not been established.

The effect of surgical approach in total hip arthroplasty on dislocation after total hip arthroplasty

The effect of surgical approach in total hip arthroplasty on dislocation after total hip arthroplasty

The effect of surgical approaches and tourniquet application on patellofemoral tracking in total knee arthroplasty

The purpose of this study was to assess the influences of surgical approaches and tourniquet application on the lateral retinacular tension (LRT). Single-setting bilateral total knee arthroplasty was performed in 10 patients, and the medial parapatellar and midvastus approaches were randomly performed on each knee using tourniquet application. The LRT was measured using the buckle transducer before and after each approach. Next, the tourniquet was deflated and the measurement was repeated. After the parapatellar approach, LRT was significantly decreased. Conversely, no significant change was seen after the midvastus approach with the tourniquet inflated. However, in the midvastus approach, LRT was significantly decreased after tourniquet deflation. We concluded that both the parapatellar and midvastus approaches influence patellar tracking and LRT. © 2003 Elsevier Inc. All rights reserved.

Surgical approach, abductor function, and total hip arthroplasty dislocation.

Dislocation is a leading early complication of total hip arthroplasty. The effect of surgical approach on instability and abductor function is a controversial topic. A comprehensive literature review was done to evaluate the correlation of surgical approach and primary total hip arthroplasty dislocation. Two hundred sixty clinical studies were identified between 1970 and 2001. Four prospective studies were identified but individually they contained insufficient power or control groups to reach statistical significance regarding surgical approach and dislocation. Fourteen studies involving 13,203 primary total hip arthroplasties met the inclusion criteria based on variables previously shown to affect stability. These studies were evaluated with respect to surgical approach and dislocation. The combined dislocation rate for these studies was 1.27% for the transtrochanteric approach, 3.23% for the posterior approach (3.95% without posterior repair and 2.03% with posterior repair), 2.18% for the anterolateral approach, and 0.55% for the direct lateral approach. Eight studies involving 2455 primary total hip arthroplasties evaluated postoperative limp. The incidence of postoperative limp was 4% to 20% for patients who had the lateral approach and 0% to 16% for patients who had the posterior approach. The quality of the literature regarding surgical approach, dislocation rates, and abductor function is limited. Larger controlled prospective studies are needed to investigate the potential benefits of the posterior approach in lieu of a dislocation rate six times higher than the direct lateral approach for primary total hip arthroplasty.

Complication Analysis in Primary Vascular Access Surgery in Patients Requiring Hemodialysis

The present study retrospectively analyzes data from 149 primary vascular access operations to evaluate the effect of surgical approach and surgical expertise on the rates of success and of complication for this surgery. All but 10 of the 149 operations involved construction of Cimino-Brescia (C-B) fistulae, the remaining 10 were loop-shunts. All operations were performed consecutively by five different surgeons who were categorized according to skill level as expert (ES), less expert (LES), or trainee (TS) surgeons. The authors recorded the types of complications, duration of patency, types and incidence of repeat surgery, adequacy of vascularization during all surgeries, time of onset of complications, surgical technique, and surgical skill level. Early complications were defined as those occurring within 30 days of surgery and late complications as those manifested thereafter. The presence of low flow in the fistulae on postoperative dialysis prompted angiography, color-Doppler echocardiography, or fistulography to diagnose the source of complication and determine surgical management. Total complications numbered 35 (23.5%), 13 (8.7%) early and 22 (14.8%) late. Inadequate vascularization resulted in a 53% complication rate, including both stenosis and thrombosis. Expert surgeons achieved 79% patency compared with 59% patency for less expert surgeons. The success rate for correction of stenosis (91.7% primary patency) was greater than that for thrombosis (50% primary patency). To preserve vascular capability, the authors prefer construction of a new, more proximal fistula for repeat surgery or (rarely) intraoperative angioplasty. If the fistula cannot be salvaged, they recommend construction of a C-B fistula on the contralateral limb. A loop-shunt is the least preferred alternative.

Effect of surgical approach on fracture healing: Comparison of minimal invasive approach (MIS) to conventional open reduction and internal fixation technique (ORIF) in a sheep tibial shaft

Schütz, Michael; Schmeling, Arno; Kääb, Max; Wieling, Ronald; Ito, Keito Author Information