Effective Surgical Technique Research Articles

Intraarticular Injections of Mesenchymal Stem Cells in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Efficacy

More than 10% of the world's population suffers from osteoarthritis (OA) of the knee, with a lifetime risk of 45%. Current treatments for knee OA pain are as follows: weight control; oral pharmacological treatment (non-steroidal anti-inflammatory drugs, paracetamol, opioids); mechanical aids (crutches, walkers, braces, orthotics); therapeutic physical exercise; and intraarticular injections of corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP). The problem is that such treatments usually relieve joint pain for only a short period of time. With respect to intraarticular injections, corticosteroids relieve pain for several weeks, while hyaluronic acid and PRP relieve pain for several months. When the above treatments fail to control knee pain, total knee arthroplasty (TKA) is usually indicated; however, although a very effective surgical technique, it can be associated with medical and postoperative (surgery-related) complications. Therefore, it seems essential to look for safe and effective alternative treatments to TKA. Recently, there has been much research on intraarticular injections of mesenchymal stem cells (MSCs) for the management of OA of the knee joint. This article reviews the latest information on the molecular mechanisms of action of MSCs and their potential therapeutic benefit in clinical practice in patients with painful knee OA. Although most recent publications claim that intraarticular injections of MSCs relieve joint pain in the short term, their efficacy remains controversial given that the existing scientific information on MSCs is indecisive. Before recommending intraarticular MSCs injections routinely in patients with painful knee OA, more studies comparing MSCs with placebo are needed. Furthermore, a standard protocol for intraarticular injections of MSCs in knee OA is needed.

Needlescopic appendectomy versus conventional laparoscopic appendectomy in young patients.

Several studies have reported that needlescopic appendectomy (NA) is a safe and effective procedure for appendicitis because of reduced trocar wounds and tissue trauma. The aim of this study was to evaluate the efficacy of NA in young patients under 40 years of age whose cosmesis matters with appendicitis by comparing it to conventional laparoscopic appendectomy (CLA). We retrospectively reviewed our database looking for patients under 40 years of age diagnosed with appendicitis who underwent NA or CLA from January 2013 to April 2017. Patients were divided into two groups: the NA group, and the CLA group. Data collected from each group included age, gender, body mass index, preoperative C-reactive protein, emergency or non-emergency settings, operative time, postoperative length of stay, postoperative complications, and pathological diagnosis. Fifty-four patients underwent NA and 53 patients underwent CLA. The groups were similar in terms of demographic features. Pathological diagnoses were divided into the following categories: catarrhalis (n=35), phlegmonous (n=37), and gangrenous (n=35). No significant difference was noted regarding the distribution of the three groups (P=.4). NA resulted in significantly shorter operative times (P=.0005), and reduced lengths of hospital stay (P=.03) as compared to CLA. There was no significant difference in the number of complications between the two groups. NA might be an effective surgical technique when performing a laparoscopic appendectomy in young patients with appendicitis.

Treatment of fistulous cranial nuchal bursitis by complete surgical resection in two horses

SummaryEquine fistulous cranial nuchal bursitis, also known as poll evil, is a serious condition that can progress to cause neurological symptoms and tetraparesis. To date, the only reported effective surgical technique to treat this condition includes the resection of a large portion of the nuchal ligament. This appears to be an outdated and overly invasive surgery with current standards. This case report describes a previously unreported surgical technique, consisting of resection of the entire cranial nuchal bursa under standing sedation and local analgesia. Two horses treated using this technique both had resolution of clinical signs and were able to return to their intended use.

Effect Of Surgical Techniques In The Treatment Of Small Saphenous Vein Insufficiency On Clinical Outcomes

Effect Of Surgical Techniques In The Treatment Of Small Saphenous Vein Insufficiency On Clinical Outcomes

Accreditation of an old surgical technique for stress urinary incontinence: long-term outcomes of modified autologous fascial pubovaginal sling.

To evaluate long-term outcomes of modified autologous fascial pubovaginal sling (AFPVS) in women with stress urinary incontinence (SUI). To evaluate long-term outcomes of modified AFPVS, we retrospectively reviewed the medical records of our patients from 2004 to 2015. From 2 decades ago, we have made modifications to classic surgical technique to make it simpler and faster. 199 patients were contacted with mean age of 52years. The mean follow-up period was 107months. According to Revised Urinary Incontinence Scale (RUIS) questionnaire, overall success rate was 83.9%. In patients with positive history for SUI surgery, success rate was 73% compared to 87% in those without it. Body mass index was negatively associated with cure rate. We did not encounter any major complications and most of the issues were managed conservatively. Recurrence of SUI occurred in 6 patients (3.5%) after initial improvement. Modified AFPVS is an effective surgical technique for treatment of SUI with high and durable success rate. At the present time with concerns regarding the use of transvaginal synthetic mesh, there is increasing interest and request for modified traditional procedures. It is likely that AFPVS may become more popular in upcoming years.

Technique and Early Outcomes for High-Energy Calcaneus Fractures Treated With Staged External Fixation to Combined Open Reduction Internal Fixation and Subtalar Arthrodesis.

(1) To present an effective surgical technique for the treatment of open and high-energy calcaneal fractures with significant soft tissue injuries. (2) To present complications with this technique and to evaluate patient-reported outcomes of staged external fixation followed by delayed reconstruction with open reduction internal fixation (ORIF) and subtalar arthrodesis. Retrospective case series. Level I trauma center. Twelve patients with 13 calcaneus fractures associated with open traumatic wounds (10 patients) or other severe soft tissue injury (ie, fracture blisters) between April 2013 and December 2019. All patients were treated with staged ankle-spanning external fixation and delayed reconstruction with ORIF with subtalar arthrodesis. Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes are presented via the domains of physical function (PF), pain interference (PI), and depression (D) in addition to visual analog score. Complications with the injury and surgical procedure were reported as well. Patients underwent initial stabilization on average 1.3 days (range, 0-12 days) from injury with stage II occurring on average 31.1 days (range, 18-42 days) from external fixation. Mean time to radiographic union was 5.6 months (range, 4-10 months). One-year mean PROMIS outcomes were as follows: PF final average of 37.4 with an average improvement of 12.2 (P < 0.01), PI final average of 62.2 with average improvement of 5.6 (P = 0.01), and D final average of 52.1 with average improvement of 6 (P = 0.12). Mean final visual analog score pain score was 3.6 with an average improvement of 2.25 (P = 0.01). Staged treatment with initial external fixation followed by ORIF and subtalar arthrodesis in the setting of highly comminuted calcaneus fractures with significant soft tissue compromise effectively addresses both bony and soft tissue concerns while providing for positive outcomes postoperatively with regards to pain and function. There were minimal complications noted for this complex injury. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

7 (PB-003) Poster Discussion - Intraoperative ultrasound is accurate for guiding breast conservative surgery in non-palpable ductal carcinoma in situ of the breast

Background: Intraoperative ultrasound guided surgery (IOUS) is an effective surgical technique for invasive breast cancer with advantages over wire localization (WL) including smaller resection volumes, lower rate of involved margins and better patient satisfaction. Nevertheless, there are few reports for ductal carcinoma in situ (DCIS) surgery. The objective of this study is to compare specimen margins and volume of excision for DCIS after IOUS vs WL.

Thoracoscopic surgery for congenital diaphragmatic hernia in neonates: Should it be the first choice?

Congenital diaphragmatic hernia (CDH) is an uncommon but potentially life-threatening surgical condition in neonates. Surgery can be performed by either open or thoracoscopic techniques. In this study, we compared the clinical efficacy, safety, and effectiveness of thoracoscopic and open CDH repair. A retrospective review of neonates with CDH who underwent operations at our hospital from 2013 to 2021 was performed. The various perioperative parameters were compared between neonates undergoing thoracoscopic and open surgery. There were 50 neonates in this study (37 in the thoracoscopic group and 13 in the open group). Thoracoscopic surgery was associated with significantly shorter hospital stay (13.32 vs. 18.77 days, p < 0.001); shorter duration of postoperative mechanical ventilation (3.70 vs. 5.98 days, p < 0.001); early feeding (4.34 vs. 7.46 days, p < 0.001); and shorter time to reach optimal feeding (8.21 vs. 13.38 days, p < 0.001). There was one postoperative death in the open group and no death in the thoracoscopic group. The median follow-up time of the two groups was 23.8 months (20.5 months in open group and 25.0 months in thoracoscopic group). Thoracoscopic surgery was associated with lower recurrence rates, but the difference was not statistically significant (2.7% vs. 7.7%, p = 0.456). Thoracoscopy CDH repair, a safe and effective surgical technique for neonates, has better cosmesis, faster postoperative recovery, and a lower recurrence rate than other procedures. It can be considered the first choice for CDH treatment for neonates among experienced surgeons.

Diagnostic Laparoscopy and its Role in Patients with Chronic Abdominal Pain: Study from a Tertiary Care Hospital

Objective: To find the efficacy of diagnostic laparoscopy and its role in patients with chronic abdominal pain. Study Design: Observational study Place and Duration of Study: Department of General Surgery, Ali Fatima Hospital/Abu Umara Medical &amp; Dental College Lahore from 1st July 2021 to 31st March 2022. Methodology: Seventy patients suffering from chronic abdominal pain were enrolled. An informed written consent was taken from each of them as an approval of participation. The age of the patients was between 20-65 years. Mostly the left side of the abdomen upper-quadrant was opted. Post creation of pneumo-peritoneum a 3 trocar technique which is standardized procedure was applied and a 10mm port through umbilical while two lateral trocars of 5 mm were used. The completed abdominal-cavity was investigated in detail initializing from the liver then gall bladder as well as anterior-surface of stomach and also the spleen. In women uterus as well as Douglas pouch was examined in context to fluid consistency, colour in addition to its site. The specimens were collected and sent to the histopathological lab for analysis. Results: The mean age of the patients was 36±15.3 years with majority were males with 55.71%. Around 45.71% patient’s pain site was at the right lower quadrant while 21.42% had left lower quadrant. The outcomes of laparoscopic investigation showed 27.10% patients to have appendix related pathology, while 19% had bands of adhesion. Conclusion: Laparoscopic proved to be an effective surgical technique in evaluating exact causes of chronic abdominal pain especially in cases where traditional methods have failed to explain the particular cause. Keywords: Bowel movement, Laparoscopy, Recurrent, Prolonged, Well-being

One-Anastomosis Gastric Bypass and Hiatal Hernia: Nissen Fundoplication with the Excluded Stomach to Decrease the Risk of Postoperative Gastroesophageal Reflux.

The realization of an antireflux valve according to the Nissen technique during the operation of one-anastomosis gastric bypass (OAGB) may theoretically decrease the incidence of postoperative reflux in patients with hiatal hernia (HH). In this retrospective study, we included all patients operated on between January 2015 and January 2019 for an OAGB associated with the creation of an antireflux Nissen valve (360-degree wrap). The patients included had type II or type III HH that had been diagnosed preoperatively or discovered intraoperatively. Twenty-two patients were operated on during the period considered. The mean preoperative BMI was 40 ± 14 kg/m2. Five patients (22.7%) had a history of bariatric surgery. Typical symptoms of gastroesophageal reflux disease (GERD) were preoperatively present in four patients (18%), and HH was revealed preoperatively only in four patients; for all the other patients, the diagnosis of HH was made intraoperatively. The rate of early and/or late postoperative complications was 0%. The mean duration of follow-up was 23 ± 15 months. No dysphagia was reported during follow-up. Three patients presented with symptomatic GERD postoperatively, including one de novo. Mean BMI at the end of follow-up was 24 ± 3 kg/m2, and the % of total weight loss was 108 ± 30%. OAGB with a Nissen antireflux valve seems to be a safe and effective surgical technique and it could be an extra arrow in the surgeon's quiver in the presence of HH in a patient scheduled for OAGB.

Clinical Effect of Minimally Invasive Microendoscopic-Assisted Transforaminal Lumbar Interbody Fusion for Single-Level Lumbar Disc Herniation.

This retrospective study aimed to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) through the Wiltse approach (W-TLIF) vs minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion (ME-TLIF) in single-segment lumbar disc herniation (LDH). A retrospective study was conducted to study the differences in specific clinical outcomes between single-segment LDH patients receiving W-TLIF and ME-TLIF. Single-segment LDH patients admitted to the Fujian Medical University Union Hospital from March 2015 to June 2018 were included. All the participants were divided into the ME-TLIF group or the W-TLIF group according to their TLIF surgery types. Demographic characteristics, the visual analog score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scale, blood loss volume, postoperative drainage, ambulated time, initial postoperative back pain, hospitalization duration, expenses, and improvement rates of patients in the two groups were collected for analysis. Radiographic fusion was ultimately assessed via the Bridwell interbody fusion grading system. All selected patients with TLIF were followed up for 1 year. Fifty-seven patients were selected, with 26 in the ME-TLIF group and 31 in the W-TLIF group, both of whom were followed up for 1 year. The mean age of the included patients was 53.75 ± 9.313 years, and the sex ratio was indiscrimination. There was no significant difference in demographic data or operating time between the two groups prior to surgery. The blood loss volume (ME-TLIF: 228.5 vs W-TLIF: 681.3), postoperative drainage (ME-TLIF:82.1 ± 23.5 vs W-TLIF: 345.8 ± 65.2), initial postoperative back pain (ME-TLIF: VAS_3 days: 1.96 ± 0.60 VAS_7 days: 1.73 ± 0.53, W-TLIF: VAS_3 days: 2.48 ± 0.51 VAS_7 days: 1.87 ± 0.43), and hospitalization duration (ME-TLIF: 9.04 vs. W-TLIF: 11.29) were all significantly lower in the ME-TILF group (p < 0.05). However, there were no statistical differences between the two groups in VAS, ODI, and JOA at 1 month, 3 months, 6 months, and 1 year postoperatively (p > 0.05). The fusion rates of the two groups showed no notable difference (p > 0.05), while the X-ray exposure time in the ME-TLIF group was significantly longer than in the W-TLIF group (p < 0.05). ME-TLIF surgery was an effective and satisfactory surgical technique to manage LDH. Although ME-TLIF increased the operation time and intraoperative fluoroscopic irradiation volume, it could effectively relieve low back pain from early postoperative onset and promote early postoperative recovery compared with W-TLIF.

The effect of surgical technique on cognitive function in elderly patients with hip fractures: Proximal femoral nailing versus hemiarthroplasty.

This study aims to compare the effects of hemiarthroplasty (HA) and proximal femoral nailing (PFN) on postoperative cognitive function in elderly adults with hip fractures. Between August 2021 and January 2022, a total of 49 patients (28 males, 21 females; mean age: 78.1±9.4 years; range, 65 to 96 years) presented with a proximal femoral fracture were included. The patients were divided into two groups based on the type of surgical technique used. Group 1 consisted of 23 patients who underwent cemented HA, while Group 2 consisted of 26 patients who underwent osteosynthesis with a PFN. Preoperatively (24 h before surgery), within the first week (Days 4 to 7), and at one month following surgery, the MiniMental State Examination (MMSE) was applied. The surgery side and duration of surgery were not significantly different between the two groups (p>0.05); however, the length of hospital stay and estimated blood loss were significantly different (p<0.001) in favor of Group 2. When the decline in MMSE scores from preoperative to postoperative was assessed, it was shown that group 2 had a lesser decrease. Patients with hip fractures who underwent PFN surgery experienced less postoperative cognitive impairment than those who underwent HA surgery.

Clinical outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF)

Background ContextIn recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has been more and more favored by spinal surgeons because of its advantages of low trauma, rapid recovery, high fusion rate and fewer complications. PurposeTo compare the clinical effects of ULIF with those of conventional open posterior lumbar interbody fusion (PLIF). Study DesignProspective case control study. Patient SampleTwenty-seven patients treated by ULIF and thirty-three patients treated by PLIF. Outcome MeasuresThe preoperative baseline and surgical technique-related outcomes (mean operation time, blood loss during operation, postoperative drainage, and postoperative hospital stay) were compared between the two groups. The clinical status of the two groups before and after surgery were also compared: visual analogue scale (VAS) score of the legs and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI). The clinical laboratory indexes of the two groups before and after the operation were compared: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), creatine phosphokinase (CPK), interleukin-6 (IL-6), tumor necrosis factor–α (TNF-α), as well as the incidence of complications, such as dural tear, nerve root injury and infection. MethodsAdult patients who underwent L3–S1 single level lumbar interbody fusion were included in the study. They were divided into a PLIF group and a ULIF group according to the type of surgery. This study comprised 60 cases: 27 cases in the ULIF group and thirty-three cases in the PLIF group. ResultsThere was no significant difference in preoperative baseline between the two groups. The ULIF group experienced less blood loss, postoperative drainage and a shorter postoperative hospital stay than the PLIF group; however the ULIF group required a longer operation time than the PLIF group (p<.05). CRP, ESR, CPK, IL-6, and TNF-α levels of the PLIF group were all significantly higher than those of the ULIF group 5 days after surgery (p<.05). The improvements in the VAS scores for back pain, VAS scores for leg pain and JOA score in the ULIF group were all significantly better than those in the PLIF group at 5 days after surgery (p<.05). There was no significant difference in fusion rate at 6 months between the 2 groups (p>.05). ConclusionsThis study showed that ULIF and PLIF were both effective surgical techniques for lumbar interbody fusion. However, ULIF caused less bleeding, reduced inflammatory reaction, less tissue damage and faster postoperative recovery compared with PLIF. Both long-term follow-up and larger clinical studies are needed to validate the clinical and radiological results of this surgery.

Foley catheter tamponade-an effective and first line management of epigastric port site bleed in laparoscopic cholecystectomy: a study of 23 cases over 20 years

Background: To study a simple yet effective surgical technique of management of epigastric port site bleed and how to prevent such an incidental surgical accident in patients undergoing laparoscopic cholecystectomy.Methods: This is a prospective pilot study done during last 20 years in patients undergoing laparoscopic cholecystectomy, who accidentally developed epigastric port-side bleed. A 22 Fr inflated Foley catheter under traction was used to control the bleeding. After an average 24-48 hours of traction tamponade, the catheter was deflated and removed accordingly.Results: The 23 patients had a complication of epigastric port bleeding, in which Foley’s catheter tamponade was used. In 22 (99.65%) cases, bleeding was controlled effectively with Foley catheter tamponade. Only in 01 patient bleeding could not be controlled with the usually applied traction, so an enhanced traction was introduced, with our indigenously fabricated external contraption. No case required wound exploration or any other sophisticated means of controlling epigastric port site bleed. There was no mortality.Conclusions: One of the most common complications of laparoscopic surgery is epigastric port site bleeding, which is an avoidable complication, provided proper procedure is followed in establishing this port.

Arachnoid cysts of the quadrigeminal cistern: Proposal of a therapeutic algorithm based on a systematic review of literature

Introduction: Although quadrigeminal arachnoid cysts (QACs) are infrequent malformations of the arachnoid space, which affect the quadrigeminal cistern, they have important clinical consequences, such as hydrocephalus and compressive symptoms. Moreover, there is much controversy on its surgical management; thus, it is important to determine the current state of the art regarding the best treatment modality. Objective: This study aimed to examine the effectiveness of different surgical approaches and revisit the anatomy of the quadrigeminal cistern. Methods: A systematic review of the literature was conducted considering studies published in the last 20 years regarding the natural course and treatment of QACs. Only English papers were selected, and case reports were excluded from the analysis. Results: We identified 286 articles, of which nine were selected for the qualitative analysis. Clinical presentations of QACs included mental disorientation, bladder incontinence, dysphagia, quadriplegia, ataxia, and nocturnal headaches, which were dependent on the cyst size, and a spontaneous resolution was not described. A microsurgical technique via a supracerebellar infratentorial approach and fenestration to the third ventricle and ventricular endoscopic third ventriculostomy were the main techniques, which were performed depending on the anatomical features and presence of hydrocephalus. Shunt placement was associated with high rates of complications and recurrence. Conclusion: Despite the lack of solid evidence on the treatment of QACs, mainly due to their rarity, an endoscopic approach with ventricle cystostomy has been indicated as the more effective surgical technique.

Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: a randomized controlled trial

BACKGROUND CONTEXTBiportal endoscopic discectomy has been frequently performed in recent years and has shown acceptable clinical outcomes. However, evidence regarding its efficacy and safety remains limited. PURPOSEThis study aimed to compare the clinical efficacy and safety of biportal endoscopic with that of open microscopic discectomy in patients with single-level herniated lumbar discs. STUDY DESIGNProspective, randomized, multicenter, open-label, assessor-blind, non-inferiority controlled trial. PATIENT SAMPLESixty-four participants suffering from low back and leg pain with a single-level herniated lumbar disc and required discectomy. OUTCOME MEASURESOutcomes were assessed with the use of patient-reported outcome measures (PROMs), visual analog scale (VAS) pain score for surgical site, low back and lower extremity, Oswestry Disability Index (ODI) for lumbar disabilities, European Quality of Life-5 Dimensions value for quality of life, and painDETECT for neuropathic pain. Surgery-related outcomes such as hospital stay, operation time, and opioid usage were collected. Adverse events occurring during the follow-up period were also noted. METHODSAll participants were randomly assigned in a 1:1 ratio to undergo biportal endoscopic (biportal group) or microscopic discectomy (microscopy group). The primary outcome was the difference in ODI scores at 12-months post surgically based on a modified intention-to-treat strategy, with a non-inferiority margin of 12.8 points. The secondary outcomes included PROMs, surgery-related outcomes, and adverse events. RESULTSThe ODI score at the 12-month follow-up was 11.97 in the microscopy group and 13.89 in the biportal group (mean difference, 1.92; 95% confidence interval [CI], -3.50 to 7.34), showing the non-inferiority of biportal group. The results for the secondary outcomes were similar to those for the primary outcome. Creatinine phosphokinase ratios were low in the biportal group. Early surgical site pain was slightly lower in the biportal group (mean difference of VAS pain score at 48-hr, -0.98; 95% CI, -1.77 to -0.19). Adverse events including reoperation showed no significant difference between the groups. CONCLUSIONBiportal endoscopic discectomy was non-inferior to microscopic discectomy over a 12 month period. Biportal endoscopic discectomy is suggested to be a relatively safe and effective surgical technique with the slight advantage of reduced muscle damage. However, the clinical implications of surgical site pain should be carefully considered.

Role of Vector Flow Mapping in Evaluating Left Ventricular Diastolic Flow Dynamics in Patients Who Underwent Mitral Valve Repair for Degenerative Mitral Regurgitation.

Mitral valve (MV) morphology after MV repair affects postoperative left ventricular (LV) blood flow pattern and long-term cardiac function. Pilot data suggest that LV diastolic vortex flow pattern changes after operation, but specific quantifiers remain unknown. We aimed to explore the role of vector flow mapping (VFM) in LV diastolic vortex flow pattern in patients who underwent MV repair. A total of 70 patients with degenerative mitral regurgitation were consecutively enrolled and 30 age- and gender-matched controls were recruited. 50 Patients who underwent MV repair were eventually included in our study. LV average energy loss (EL-AVE) during diastole was measured in the MV repair group by VFM one week before and one month after the operation, and compared with that of controls using one-way analysis of variance. The effect of surgical techniques and the extension of leaflet degeneration on postoperative EL-AVE were analyzed using muti-way analysis of variance, and patients were categorized into a resection subgroup (n = 29) and a non-resection subgroup (n = 21). The EL-AVE one month after operation in the MV repair group was decreased (p 0.001) compared to that one week before the operation, and was increased (p 0.001) compared to that in controls. Mitral leaflet resection had a statistically significant effect on postoperative EL-AVE. The EL-AVE of the resection subgroup was higher than that of non-resection subgroup (p 0.001). VFM can be used to evaluate the diastolic blood flow pattern of LV after MV repair, and to observe the changes of LV blood flow pattern caused by different surgical techniques. VFM may be a potential new hemodynamic evaluation method after MV repair.

Lumboperitoneal Shunt Preference in Treatment of Patients with Normal Pressure Hydrocephalus

Objective: To demonstrate the advantages of Lumboperitoneal (LP) shunt surgery applied to patients with normal pressure hydrocephalus (NPH).Methods: Preoperative, intraoperative and postoperative data of 20 patients who underwent LP shunt surgery for NPH between 01/01/2012 and 07/04/2022 at the Neurosurgery Clinic of Ordu University Training and Research Hospital were analyzed. The demographic, clinical and laboratory data of the patients as well as their medical records were reviewed. Patients who underwent LP shunt with the diagnosis of normal pressure hydrocephalus in our clinic were screened retrospectively, and the success rates and complications after the surgical intervention applied to these patients were recorded.Results: Statistically significant improvements were recorded in Modified Ranking Scale Scores and Mini-Mental State Examination Scores at the end of the first year. The incidence of Gait Disturbance did not differ significantly by gender, The incidence of dementia did not differ significantly by gender, The incidence of urinary incontinence showed a significant change according to gender While all of the women diagnosed with normal pressure hydrocephalus had urinary incontinence in the preoperative period, this rate was seen in only 66.7% of the men. Gait disturbance improved in 80%, urinary incontinence in 60%, and cognitive functions in 60% of patients. No neurogenic complication developed in our operated patients. Wound infection occurred at the abdominal incision site in only two patients (10%). Subcutaneous hematoma occurred in the abdominal region in one patient (5%). Conclusion: LP shunt surgery has a lower complication rate than VP shunt surgery and is a more easily applicable surgical technique. LPS surgery is a safe and minimally invasive treatment method. It has lower complication rates compared to VPS . LPS surgery is an effective surgical technique. It can be used as an alternative to the VPS procedure in the treatment of NPH patients

Early and late complication of sleeve gastrectomy

The rate of obesity is on rise worldwide and almost 13% of the global population is obese leading to development of various other diseases and complications. Lack of effective outcome from conventional approach for weight control and loss is causing a transition among people to approach for bariatric surgeries. Sleeve gastrectomy is one of the surgical techniques of bariatric surgery aimed to achieve weight loss. Like any other surgical procedure, it also has certain post-operative complications associated with it. The complications of sleeve gastrectomy are further divided into early and late phase. The purpose of this research is to review the available information about early and late complication of sleeve gastrectomy. In the surgical treatment of morbid obesity, sleeve gastrectomy is the most widely performed bariatric procedure. It is a minimally invasive and risk-free surgery with a low risk of complications and death. The complication rates for early and late complication range from 5.4% to 7.3%, with incidence of serious complications ranging from 1.2% to 2.2%. Early complications include bleeding such as intraluminal or extraluminal, a leak in the staple line, and the formation of an abscess. While gastric stenosis, nutritional shortages, mediastinal pouch migration, and the development or worsening of gastroesophageal reflux disease are all late consequences. Older age, male sex, increased body mass index, smoking, and comorbidities are considered the risk factors for the development of complications of sleeve gastrectomy. Overall, sleeve gastrectomy is considered a safe and effective surgical weight loss technique.

Biomechanical comparative analysis of effects of dynamic and rigid fusion on lumbar motion with different sagittal parameters: An in vitro study

Background: Although the management of the lumbar disease is highly dependent on the severity of the patient’s condition, optimal surgical techniques to reduce the risk of adjacent degeneration disease (ADS) remain elusive. Based on in vitro biomechanical tests of the cadaver spine, this study aimed to comparatively analyze the kinematic responses of the spine with dynamic and rigid fixations (i.e., Coflex fixation and posterolateral fusion) after single-or double-level lumbar fusion in daily activities. Methods: Six human lumbar specimens (L1-S1) were selected for this experiment, and the sagittal parameters of each lumbar specimen were measured in the 3D model. The specimens were successively reconstructed into five groups of models: intact model, single-level L4-5 Coflex fixation model, single-level L4-5 Fusion (posterior pedicle screw fixation) model, double-level L4-5 Coflex + L5-S1 Fusion model; and double-level L4-5 Fusion + L5-S1 Fusion model. The pure moment was applied to the specimen model to simulate physiological activities in daily life through a custom-built robot testing device with an optical tracking system. Results: For single-level lumbar fusion, compared to the traditional Fusion fixation, the Coflex dynamic fixation mainly restricted the extension of L4-L5, partially retained the range of motion (ROM) of the L4-L5 segment, and reduced the motion compensation of the upper adjacent segment. For the double-level lumbar fixation, the ROM of adjacent segments in the Coflex + Fusion was significantly decreased compared to the Fusion + Fusion fixation, but there was no significant difference. In addition, PT was the only sagittal parameter of the preoperative lumbar associated with the ROM under extension loading. The Coflex fixation had little effect on the original sagittal alignment of the lumbar spine. Conclusion: The Coflex was an effective lumbar surgical technique with a less altering kinematic motion of the lumbar both at the index segment and adjacent segments. However, when the Coflex was combined with the fusion fixation, this ability to protect adjacent segments remained elusive in slowing the accelerated degradation of adjacent segments.