Effect Of Different Surgical Approaches Research Articles

Parathyroid Carcinoma: A Rare Endocrine Malignancy

Introduction: Parathyroid carcinoma is a rare neoplasm that may present sporadically or in the context of a genetic syndrome. Diagnosis and management are challenging due to the lack of consensus on the optimal management strategy. Case report: We report the case of a 51years old male, diagnosed initially with parathyroid carcinoma, and presented recurrence and lymph node involvement. Conclusions: Parathyroid carcinoma is a very rare cancer, that continues to pose considerable challenges in terms of diagnosis and management. The aim of parathyroid carcinoma therapy is not only oncological, but also to achieve biochemical remission. Surgery is the gold standard treatment of this entity. Future prospective randomized studies are needed to assess the effects of different surgical approaches on morbidity, mortality and oncological outcomes. Keywords: Parathyroid - Carcinoma - Hyperparathyroidism - Management - Prognosis.

Effects of different surgical approaches on health-related quality of life in pediatric and adolescent patients with papillary thyroid carcinoma

ObjectiveWe aimed to compare the health-related quality of life (HRQOL) in pediatric and adolescent patients with papillary thyroid carcinoma who underwent bilateral or unilateral thyroidectomy.MethodsThis prospective observational study recruited children and adolescents diagnosed with papillary thyroid carcinoma at low risk of recurrence. Participants were categorized into bilateral or unilateral thyroidectomy groups. They were asked to complete one questionnaire regarding basic information and three others regarding quality of life. HRQOL data from patients who underwent different procedures at various time points were compared.ResultsThirty patients underwent unilateral thyroidectomy and 54 bilateral thyroidectomy (median age = 14.27 years). HRQOL of the unilateral thyroidectomy group was higher than the bilateral group.ConclusionFor children and adolescents with papillary thyroid carcinoma at low risk of recurrence, bilateral thyroidectomy is associated with a lower HRQOL than unilateral thyroidectomy. Surgeons should consider tumor impact and HRQOL when selecting the most appropriate surgical method.

Effect of different surgical approaches on the survival and safety of Siewert type II esophagogastric junction adenocarcinoma: a systematic review and meta-analysis

BackgroundWhether a transthoracic (TT) procedure by a thoracic surgeon or a transabdominal (TA) by a gastrointestinal surgeon is best for Siewert type II esophagogastric junction adenocarcinoma (EGJA) remains unknown. Survival and perioperative outcomes were compared between the two groups in this meta-analysis to clarify this argument.MethodsWe searched 7 databases for eligible studies comparing TT and TA procedures for Siewert type II EGJA. The final analyzed endpoints included intraoperative and hospitalization outcomes, recurrence, complication, and survival.ResultsSeventeen studies involving 10,756 patients met the inclusion criteria. The TA group had higher rates of overall survival (OS) (HR: 1.31 [1.20 ~ 1.44], p < 0.00001) and disease-free survival (DFS) (HR: 1.49 [1.24 ~ 1.79], p < 0.0001). The survival advantage of OSR and DFSR increased with time. Subgroup analysis of OS and DFS suggested that TA remained the preferred approach among all subgroups. More total/positive lymph nodes were retrieved, and fewer lymph node recurrences were found in the TA group. The analysis of perioperative outcomes revealed that the TA procedure was longer, had more intraoperative blood loss, and prolonged hospital stay. Similar R0 resection rates, as well as total recurrence, local recurrence, liver recurrence, peritoneal recurrence, lung recurrence, anastomosis recurrence and multiple recurrence rates, were found between the two groups. The safety analysis showed that the TT procedure led to more total complications, anastomotic leakages, cases of pneumonia, and cases of pleural effusion.ConclusionsThe TA procedure appeared to be a suitable choice for patients with Siewert type II EGJA because of its association with longer survival, fewer recurrences, and better safety.

Biomechanical Comparison of Different Surgical Approaches for the Treatment of Adjacent Segment Diseases after Primary Transforaminal Lumbar Interbody Fusion: A Finite Element Analysis.

Adjacent segment disease (ASD) is a well-known complication after interbody fusion. Revision surgery is necessary for symptomatic ASD to further decompress and fix the affected segment. However, no optimal construct is accepted as a standard in treating ASD. The purpose of this study was to compare the biomechanical effects of different surgical approaches for the treatment of ASD after primary transforaminal lumbar interbody fusion (TLIF). A finite element model of the L1-S1 was conducted based on computed tomography scan images. The primary surgery model was developed with a single-level TLIF at L4-L5 segment. The revision surgical models were developed with anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), or TLIF at L3-L4 segment. The range of motion (ROM), intradiscal pressure (IDP), and the stress in cages were compared to investigate the biomechanical influences of different surgical approaches. The results indicated that all the three surgical approaches can stabilize the spinal segment by reducing the ROM at revision level. The ROM and IDP at adjacent segments of revision model of TLIF was greater than those of other revision models. While revision surgery with ALIF and LLIF had similar effects on the ROM and IDP of adjacent segments. Compared among all the surgical models, cage stress in revision model of TLIF was the maximum in extension and axial rotation. The IDP at adjacent segments and stress in cages of revision model of TLIF was greater than those of ALIF and LLIF. This may be that direct extension of the surgical segment in the same direction results in stress concentration.

Efficacy of Varying Surgical Approaches on Achieving Optimal Alignment in Adult Spinal Deformity Surgery.

The Roussouly, SRS-Schwab, and GAP classifications define alignment by spinal shape and deformity severity. The efficacy of different surgical approaches and techniques to successfully achieve these goals is not well understood. Identify the impact of surgical approach and/or technique on meeting complex realignment goals in adult spinal deformity(ASD) corrective-surgery. Retrospective. Included: ASD patients fused to pelvis with two-year(2Y) data. Patients were categorized by: 1)Roussouly: matching current and theoretical spinal shapes; 2)improving in SRS-Schwab modifiers(0, +, ++); 3)improving GAP Proportionality by 2Y. ANCOVA and multivariable logistic regression analyses controlling for age, levels fused, baseline deformity, and three-column osteotomy usage compared the effect of different surgical approaches, interbody and osteotomy use on meeting realignment goals. 693 ASD patients were included. By surgical approach, 65.7% were posterior-only and 34.3% underwent anterior-posterior(AP) approach with 76% receiving an osteotomy(21.8% 3CO). By 2Y, 34% matched Roussouly, 58% improved in GAP, 45% in SRS-Schwab PT, 62% SVA, and 70% PI-LL. Combined approaches were most effective for improvement in PT(OR: 1.7,[1.1-2.5]) and GAP(OR: 2.2,[1.5-3.2]). Specifically, ALIFs below L3 demonstrated higher rates of improvement versus TLIFs in Roussouly(OR: 1.7, [1.1-2.5]) and GAP(OR: 1.9, [1.3-2.7]). Patients undergoing PSO at L3 or L4 were more likely to improve in PT(OR: 2.0,[1.0-5.2]) and PI-LL(OR: 3.8[1.4-9.8]). Clinically, patients undergoing combined approach demonstrated higher rates of meeting SCB in ODI by 2Y while minimizing rates of PJF, most often with an ALIF at L5-S1(ODI-SCB: OR: 1.4,[1.1-2.0];PJF: OR: 0.4,[0.2-0.8]). Among patients undergoing ASD realignment, optimal lumbar shape and proportion can be achieved more often with a combined approach. While TLIFs incorporating a three-column osteotomy at L3 and L4 can restore lordosis and normalize pelvic compensation, ALIFs at L5-S1 were most likely to achieve complex realignment goals with an added clinical benefit and mitigation of junctional failure.

The effects of different surgical approaches on the psychological status, medical coping mode and quality of life of patients with lung cancer.

This study aimed to compare the effects of robot-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and thoracotomy on the psychological status, medical coping mode, and quality of life of patients with lung cancer. A total of 158 patients with lung cancer were selected from the thoracic surgery center of a third-grade hospital in Hunan Province, China, from September to November 2020. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Medical Coping Modes Questionnaire (MCMQ), and Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36) were used to assess the effects of the surgical approaches on the study parameters before and 48-96 h after surgery. The t-test and analysis of variance were used to analyze the data. The results revealed that the patients' depression increased, their short-term quality of life decreased, and they tended to adopt a positive coping mode after surgery (p < 0.05). The RATS and VATS groups differed in avoidance dimension of medical coping modes (p < 0.05). The VATS and thoracotomy groups differed in the body pain dimension of quality of life (p < 0.05). Different surgical approaches had no effect on the psychological status, medical coping modes except the avoidance dimension, and quality of life except the body pain dimension. Surgical approaches have little effect on the psychological status, medical coping modes, and quality of life of patients with lung cancer; however, their depression increased and quality of life decreased after the surgery.

Impact of sentinel lymph node biopsy through the axillary cribriform fascia approach on intraoperative indicators and postoperative complications.

The aim of this study was to compare intraoperative indicators and postoperative complications of sentinel lymph node biopsy (SLNB) via the axillary cribriform membrane and traditional axillary fold with blue dye to make a priority choice. This single-center, retrospective cohort study enrolled 330 eligible breast cancer patients with stage of cTis ~ 2N0M0 in our hospital from August 2018 to July 2021. Multiple linear and binary logistic regression were used to evaluate the effects of different surgical approaches on intraoperative indicators (drainage volume, tube time, intraoperative bleeding, operative time and the number of sentinel lymph nodes (SLNs)) and postoperative complications (upper limb edema and dysfunction). All statistical tests were two sided. Multiple linear and logistic regression results after adjusting the covariate showed that the axillary cribriform fascia approach could render more greater intraoperative indictors and reduce the risk of upper limb dysfunction (P = 0.038, OR 0.32, 95%CI 0.11-0.94). High BMI could increase the drainage volume, tube time and operative time. There was no significant difference in the number of SLNs between the two approaches and it also had no relationship with intraoperative indicators and postoperative complications. Overall, 6 (1.8%) experienced upper limb edema and 18 (5.5%) experienced upper limb dysfunction. Univariate logistic regression analysis showed that radiotherapy increased the risk of upper limb edema (P = 0.032, OR = 12.76, 95%CI 1.25-130.06). SLNB through the axillary cribriform fascia approach produces more satisfied intraoperative indictors, a lower risk of upper limb dysfunction.

Corporotomy localization in inflatable penile implant surgery: learning curve and comparing different surgical approaches in high volume surgeons

Inflatable penile prostheses (IPP) is a viable solution for patients with erectile dysfunction unresponsive to or with contraindications for conservative treatment. In contrast to rapporting of IPP design and material modifications, no data exist regarding the effect of different surgical approaches during IPP implantation on the corporotomy site. The purpose of the present multi-center study was to investigate different IPP implantation surgical approaches and their influence the corporotomy site, while the effect of learning curve on the corporotomy site was also evaluated. Data was collected from 6 high-volume IPP surgeons. Surgical notes were searched for incision site, proximal and distal corporal length measurement, total length measurement, total cylinder length, length of rear tip extenders (RTE), surgery time, type of implant and reservoir placement while postoperative complications were also reported. The association between proximal/distal corporal length, the recorded covariates and infectious complications were examined. 1757 patients with virgin 3-piece IPP implantation were included in the analysis. The proximal/distal ratio averaged at 0.829 (SD ±0.293) in penoscrotal incisions (N=782), 0.687 (SD± 0.245) in infrapubic (N=1664) and 0.724 (SD± 0.179) in subcoronary (N=972) incisions. No significant differences where observed in the three highest volume surgeons. Correcting for significant covariates (diabetes mellitus, RTE, age) did not change this outcome. In the three highest volume surgeons, a more proximal incision resulted in significantly less RTE use. There was no difference in infectious complications with different surgical techniques (p = 0.280). Focusing on the data of the principal center, we found a decrease in the proximal/distal ratio of 8.41% per additional year of experience. We were unable to draw a firm conclusion about the difference in corporotomy site between different surgical approaches as such, but we found no significant difference between the highest volume surgeons using different techniques. Nevertheless, a significant effect of experience on the proximalization of the corporotomy was reported. none

Effect of different surgical approaches on the prognosis of patients with postoperative radiotherapy for stage IIB–IVA esophageal squamous cancer

ObjectiveTo investigate the effect and clinical significance of different thoracic surgical approaches for patients with stage IIB–IVA esophageal squamous cell carcinoma on the survival and prognosis of postoperative radiotherapy patients.MethodsOne hundred thirty-two patients with stage IIB–IVA esophageal squamous cancer who received radiotherapy after surgery were screened for baseline characteristics and survival analysis. The Kaplan-Meier method was used to draw the survival curve for the follow-up data, and the log-rank test was used to compare the difference in survival rate between the two groups. The Cox regression model was used for multivariate survival analysis.ResultFor stage IIB–IVA esophageal squamous cell carcinoma, the results of multivariate analysis showed that different surgical methods and clinical staging were independent factors affecting the survival and prognosis of patients after radiotherapy. The 1-, 3-, and 5-year survival rates of patients with advanced esophageal cancer through the left chest approach were 84.2%, 61.4%, and 36.8% respectively. The 1-, 3-, and 5-year survival rates of patients with advanced esophageal cancer through the right chest approach were 73.3%, 40.0%, and 21.3% respectively. There was no significant difference in the 1-year survival rate (P = 0.135) between the two surgical procedures. The 3-year survival rate (P < 0.05) and the 5-year survival rate (P < 0.05) were significantly different.ConclusionFor patients with stage IIB–IVA esophageal squamous cell carcinoma undergoing radiotherapy after surgery, the long-term survival prognosis of patients after the left thoracic approach is significantly higher than that of the right thoracic approach.

178 The Effect of Ophthalmic Surgery for Graves’ Orbitopathy on Quality of Life – A Systematic Review and Meta-Analysis

Abstract Background Graves’ orbitopathy has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia and improve aesthetics. We aimed to quantify the effect of different surgical approaches on quality of life. Method Electronic databases were used from inception until 22nd March 2021 to identify studies assessing quality of life pre- and post-surgical intervention for Graves’ orbitopathy. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilised. Results 10 articles comprising 632 patients were included. All used the Graves’ Ophthalmopathy Quality of Life questionnaire (GO-QOL). For GO-QOL appearance, the pooled standardised mean improvement for patients after surgery was +0.72 (95% CI 0.50–0.94) I2=69% (95% CI 52–80%). For GO-QOL visual functioning, the pooled SMD for patients after surgery was +0.41 (95% CI 0.25–0.58) I2=60% (95% CI 36–74%). For visual appearance, orbital decompression yielded the greatest improvement (SMD+0.84, 95%CI 0.54–1.13) followed by eyelid surgery (SMD+0.38, 95% CI 0.05–0.70), while strabismus correction had no significant effect (SMD +0.94, 95% CI -0.10–1.99). Conversely strabismus correction was associated with the greatest improvement (SMD+1.25, 95%CI 0.29–2.21) in visual functioning, outperforming orbital decompression (SMD+0.29, 95%CI 0.15–0.43) and eyelid surgery (SMD+0.12, 95%CI -0.18–0.41). Conclusions Ophthalmic surgery results in substantial improvements in quality of life in patients with Graves’ orbitopathy, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance, strabismus surgery may benefit both visual appearance and function equally whereas eyelid surgery benefits appearance alone.

Oncological Safety of Laparoscopic Surgery for Women with Apparent Early-stage Uterine Clear Cell Carcinoma: A Multicenter Retrospective Cohort Study

To study the effect of different surgical approaches (laparoscopy and laparotomy) on the oncological outcomes of patients with apparent early-stage uterine clear cell carcinoma (UCCC). Retrospective cohort study. Four Chinese teaching hospitals. A total of 273 women with apparent early-stage UCCC. All included patients were surgically staged by laparoscopy or laparotomy. The eligible patients were divided into the laparotomy group and the laparoscopy group. Disease-free survival (DFS) and overall survival (OS) were evaluated by the Kaplan-Meier method and compared by the log-rank test. The Cox proportional hazards regression model was used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the effect of surgical approach on DFS and OS. With a median follow-up of 31.0 months, the 3-year DFS rates were 68.82% and 64.27% in the laparotomy group and the laparoscopy group, respectively. The difference in DFS between the 2 groups was not statistically significant (HR, 1.06; 95% CI, 0.72-1.58; p=.758). In addition, the 3-year OS rate (72.76% vs 73.46%; HR, 1.06; 95% CI, 0.65-1.72; p=.823) was not different between the 2 groups. Furthermore, multivariable analysis showed that for patients with apparent early-stage UCCC, the approach of surgical staging was not an independent prognostic factor for OS (adjusted HR, 1.29; 95% CI, 0.78-2.12; p=.321) and DFS (adjusted HR, 1.11; 95% CI, 0.73-1.68; p=.621). For clinical early-stage clear cell carcinoma of the uterus, staging by laparoscopy is oncologically safe. This needs to be justified by further prospective studies.

Вплив різних хірургічних доступів при протезуванні аортального клапана на ступінь вираженості операційного стресу і системної запальної реакції

Метою даної роботи була оцінка впливу мінімально інвазивної J-подібної стернотомії і поздовжньої серединної стернотомії (ПСС) на ступінь вираженості операційного стресу і системної запальної реакції при протезуванні аортального клапана (ПАК). На підставі обстеження 44 пацієнтів із застосуванням мінімально інвазивного доступу (МІД) і 54 пацієнтів із застосуванням ПСС було показано, що у разі застосування МІД спостерігається менш виражена системна запальна реакція організму, що підтверджується більш низькими концентраціями в плазмі ключових прозапальних цитокінів (фактора некрозу пухлини альфа — у середньому на 5,8 пг/мл (в 1,6 раза), інтерлейкіну-6 — у середньому на 5,3 пг/мл (у 2,3 раза)) та деяких протеїнів гострої фази запалення (С-реактивного протеїну — у середньому на 23,5 мг/л (в 1,8 раза) та концентрації фібриногену — у середньому на 1,3 г/л (в 1,3 раза)). До того ж під час роботи було визначено, що застосування мінімально інвазивного доступу для виконання ПАК порівняно з традиційною поздовжньою серединною стернотомією супроводжується менш вираженою стрес-індукованою перебудовою гормонального гомеостазу, що також об’єктивно підтверджує перевагу мінімально інвазивного доступу над поздовжньою серединною стернотомією.

The Effect of Ophthalmic Surgery for Graves' Orbitopathy on Quality of Life: A Systematic Review and Meta-Analysis.

Background: Graves' orbitopathy (GO) has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia, and improve aesthetics. We sought to quantify the effect of different surgical approaches on quality of life. Methods: Electronic databases Ovid-MEDLINE and EMBASE were used from inception until March 22, 2021, to identify studies assessing quality of life pre- and postsurgical intervention for GO. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilized. Results: Ten articles comprising 632 patients with a mean age of 48.4 years (range 16-85 years) were included. All used the Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire. For GO-QOL appearance, the pooled standardized mean improvement for patients after surgery was +0.72 (95% confidence interval [CI 0.50-0.94]), I2 = 69% [CI 52-80%]. For GO-QOL visual functioning, the pooled standardized mean difference (SMD) for patients after surgery was +0.41 [CI 0.25-0.58], I2 = 60% [CI 36-74%]. For visual appearance, orbital decompression yielded the greatest improvement (SMD +0.84 [CI 0.54-1.13]) followed by eyelid surgery (SMD +0.38 [CI 0.05-0.70]), while strabismus correction had no significant effect (SMD +0.94 [CI -0.10 to 1.99]). Conversely strabismus correction was associated with the greatest improvement (SMD +1.25 [CI 0.29-2.21]) in visual functioning, outperforming orbital decompression (SMD +0.29 [CI 0.15-0.43]) and eyelid surgery (SMD +0.12 [CI -0.18 to 0.41]). A mean improvement in GO-QOL of greater than 10 points after orbital decompression surgery was achieved in 12/14 (86%) patient groups for appearance and 5/14 (36%) patient groups for visual functioning. A mean improvement of greater than 6 points was achieved in 5 of 6 (83%) patient groups for strabismus surgery for both appearance and visual functioning. A mean improvement of greater than 6 points after eyelid surgery was achieved in 2/3 (67%) patient groups and 0/3 patient groups for visual appearance and functioning, respectively. Conclusion: Ophthalmic surgery results in substantial improvements in quality of life in patients with GO, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance; strabismus surgery may benefit both visual appearance and function equally, whereas eyelid surgery benefits appearance alone.

Is the facial nerve at risk following surgical correction of mandibular condylar fracture: A systematic review and meta-analysis.

To review the literature on the effect of different surgical approaches on facial nerve injuries. The present systematic review addresses the following focus question: Is the facial nerve at risk following surgical correction of mandibular condylar fracture? Electronic and manual literature searches were conducted on databases:PubMed, ScienceDirect and Google scholar,Cochrane and clinicaltrials.gov for studies published until July 2020 to collect information about the effect of different surgical approaches on facial nerve injuries. Systematic literature review was performed following the prisma guidelines to identify studies. Quantitative retrospective and prospective studies,controlled trials,controlled clinical trials were included;case reports and review articles were excluded from this systematic review. 1500 articles published till July 2020 was identified. 116 articles met inclusion criteria. After applying exclusion criteria seven articles were shortlisted. The level of heterogeneity was observed to be less than 50%, between all parameters for all studies making publication bias to be minimum. On comparing various studies statistically using Z-test for all parameters,it was observed that level of significance was significant for various findings like Displacement/Dislocation of fracture and transient facial nerve weakness was found to be statistically significant between all studies (p-value <0.05). Odd ratio, relative ratio and 95% CI was derived for all parameters recorded for various studies. Due to less number of subjective studies, and variability in study designs and lack of reporting on confounding factors,definitive conclusions on effect of various surgical approaches on facial nerve injury cannot be drawn Future well-designed long-term randomized controlled trials are necessary to reveal the necessary correlation between both the parameters.

The Effect of Different Surgical Approaches of Ultrasound-Guided Quadratus Lumborum Block on the Analgesic Effect in Cesarean Section

Objective To study the effect of different surgical approaches of ultrasound-guided quadratus lumborum block on the analgesic effect in cesarean section. Methods 150 parturients underwent elective caesarean section in our hospital from February 2017 to February 2020 were enrolled in this study. They were divided into observation group and control group according to the method of random number table, with 75 cases in each group. In control group, anterior QLB was used, while in observation group, posterior QLB was used. The operation process was performed by the same anesthesiologist. If the injection situation was not ideal, the position of needle tip was timely adjusted. Both groups were given sufentanil 100 HQ/kg (diluted with 100 mL normal saline) and a single addition of morphine 50 mg (diluted with 100 mL normal saline) for self-controlled analgesia after operation. The postoperative time to first water intake, the time to first discharge from bed, hospital stay and satisfaction degree of labor pain were compared between the two groups. The numerical pain score (NRS) and visual analogue scale (VAS) scores of rest and movement at different time after operation were compared. The dosage of sufentanil and morphine in perioperative period and the occurrence of postoperative adverse reactions were compared between the two groups. Results The time to first water intake, the time to first discharge from bed and hospital stay in the observation group were significantly shorter than those in the control group (P &lt; 0.05), and the satisfaction score of analgesia in the observation group was significantly higher than that in the control group (P &lt; 0.05). The NRS score of observation group at TO, 1, 2, 3 and 4 after operation was significantly lower than that of control group (P &lt; 0.05). There was no significant difference in VAS score of rest and movement at 4 and 8 h after operation between the two groups (P &gt; 0.05); the VAS score of rest and movement at 12 and 24 h after operation in observation group was significantly lower than that in control group (P &lt; 0.05). The amount of sufentanil and morphine used in the perioperative period in the observation group was significantly less than that in the control group (P &lt; 0.05). The total incidence rate of adverse reactions in observation group was not significantly different from that in control group (P &gt; 0.05). Conclusion Both anterior and posterior QLB can provide analgesia after cesarean section, but posterior QLB can better relieve the postoperative pain of parturients, which is worth popularizing in clinic.

The effects of capsular repair on quality of life after hip arthroplasty with the anterolateral approach

Background/Aim: Hip fractures, commonly observed worldwide, cause severe functional problems and pose an economic burden. This study investigated the effects of different surgical approaches of joint capsule repair on morbidity and mortality and aimed to increase the quality of life after surgery with the most proper treatment option. Methods: This prospective case-control study was conducted on 186 patients over 65 years of age admitted to our clinic from 2006 to 2012 for displaced femoral neck fracture. All patients were treated via a hemiarthroplasty. The patients (66 males, 110 females with an overall mean age of 80.43 years (70-90)) were followed up regularly. All patients were divided into two groups: Group 1 was treated with capsular repair, and Group 2 without. The groups were compared in terms of pre-and peri-operative data, demographics, concomitant diseases, post-operative complications, mortality rates, pain level, and hip scores. Hospitalization time, average surgical duration, and time from fracture to the operation were also noted. Results: We found no significant differences between the groups in terms of surgery preferences (P>0.05). The survival of patients was significantly higher, blood loss was significantly less, and perioperative mortality rates were insignificantly lower in the noncapsular repair group (p=0.005, p=0.015, and p=0.515, respectively). Conclusion: The use of capsule repair during hip hemiarthroplasty in patients over 65 years of age had no negative impact on mortality or morbidity. Surgical preference changes during hip arthroplasty procedures are essential.

Global Analysis of Research Trends on Kidney Function After Nephron-Sparing Surgery: A Bibliometric and Visualised Study.

BackgroundNephron-sparing surgery (NSS) for small renal masses (SRMs) is currently the standard of care to treat renal cell carcinoma (RCC). The concept of partial resection of RCC has mainly been developed to preserve kidney function. Therefore, we have performed this study to explore the research activity that has been undertaken since the early twenty-first century to investigate the advantages of NSS on preserving kidney function and preventing chronic kidney disease (CKD).MethodsBased on the Scopus database, this bibliometric study was used to reveal publication patterns in the kidney function and NSS research field. The data were analysed with VOSviewer version 1.6.16 software, which was used to create a network visualisation map that included research hotspots in this area.ResultsA total of 449 scientific publications focused on renal function in NSS between 2001 and 2020. One hundred and seventy (38%) of the total published articles originated from the USA. Journal of Urology, European Urology, and Journal of Endourology were the top publications detailing research in this field. Half (50%) of the top 10 cited articles were published in the Journal of Urology, with an average citation of around 200 per article. The three most encountered research themes were comparative studies between partial and radical nephrectomy in terms of kidney function and development of CKD, the impact of type and duration of ischemia during resection on glomerular filtration rate (GFR) decline, and the effect of different surgical approaches on intermediate and long-term kidney function.ConclusionNSS for SRMs and RCC and its impact on kidney function is a hot topic in the literature, and the amount of published data has consistently been rising since 2000. However, even though hundreds of documents have studied this topic from various perspectives, there is a compelling need to answer several questions such as the overall survival (OS) benefit of performing NSS in localised RCC and head-to-head comparison of robotic-assisted versus laparoscopic NSS in terms of warm ischemia time and long-term decline in GFR.

Analysis of Approaches in the Microsurgical Treatment of 102 Cases of Petroclival Meningioma in a Single Center.

Objectives: We identified the optimal approaches for treating the diverse tumor subtypes of petroclival meningioma (PM) by analyzing the clinical benefits of various surgical approaches adopted for each subtype.Methods: Tumors in 102 PM patients from a single center who underwent surgical treatment were classified as upper clivus (UC), cavernous sinus (CS), tentorium (TE), or petrous apex (PA) types based on the attachment site of the tumor base and the displacement of the trigeminal nerve. The therapeutic effects of different surgical approaches among the subtypes were evaluated according to the patient outcomes.Results: The subtemporal (33.33%), retrosigmoid (16.67%), and Kawase approaches (50%) were used for the UC type. Simpson I/II resection was achieved in 46.66% of patients with the Kawase approach. Significant differences were found between the other two approaches (P = 0.044) and in the follow-up Karnofsky performance scale (KPS) scores (P = 0.008). The subtemporal (60%) and Kawase approaches (40%) were used for the CS type; neither approach achieved Simpson I/II resection. The retrosigmoid (25.81%) and Kawase approaches (74.19%) were used for the TE type. The Simpson I/II resection rates of the two approaches were 55.55 and 86.95%, respectively, and a significant difference was observed between them (P = 0.039). The retrosigmoid (43.75%) and Kawase approaches (56.25%) were used for the PA type. The Simpson I/II resection rates of the two approaches were 31.25 and 50%, respectively. The resection degrees of the two approaches and the KPS scores at follow-up were significantly different (P = 0.034).Conclusion: The individual microsurgical approaches adopted for the various PM tumor subtypes can provide maximal safe resection and good KPS scores. The Kawase approach is more suitable for PM, especially for UC- and PA-type PM tumors.

Surgical Approach of Open Reduction and Internal Fixation for Proximal Humeral Fracture in the Elderly

Background: The incidence of proximal humeral fracture is increasing gradually. Many patients choose open reduction and internal fixation. With the maturity of surgical technology and thought, people begin to think about the optimization of surgical effect from the surgical incision, including less trauma, less bleeding, less postoperative complications and fast postoperative recovery. However, due to the complexity of shoulder anatomy, scholars have created different surgical approaches from different perspectives. Objective: Although the effect of open reduction and internal fixation is confirmed, there are still some differences in the effect of different surgical approaches. We need to study the summary and research progress of surgical approach for proximal humeral fracture, which is conducive to the selection of the optimal approach for incision, so as to improve the prognosis. Method: Selective literature review. Result: At present, common surgical approaches include lateral approach, anteromedial approach, anterolateral approach, small incision approach and other approaches. This paper describes and compares the advantages and disadvantages of each approach, so as to choose the best approach for different fracture types. Conclusion: Based on the complexity of the anatomical relationship of the shoulder joint, the displacement, classification of the fracture, the proximal humerus are opened and exposed from different perspectives. Choosing a safe surgical approach is one of the key links of the whole operation and plays an important role in the postoperative effect. In this paper, the common approaches and new approaches of open reduction and internal fixation for proximal humeral fracture are reviewed, which provides new ideas for the design of surgical scheme.

Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation.

A parastomal hernia is defined as an incisional hernia related to a stoma, and belongs to the most common stoma-related complications. Many factors, which are considered to influence the incidence of parastomal herniation, have been investigated. However, it remains unclear whether the enterostomy should be placed through, or lateral to the rectus abdominis muscle, in order to prevent parastomal herniation and other important stoma complications. To assess if there is a difference regarding the incidence of parastomal herniation and other stoma complications, such as ileus and stenosis, in lateral pararectal versus transrectal stoma placement in people undergoing elective or emergency abdominal wall enterostomy. For this update, we searched for all types of published and unpublished randomized and non-randomized studies in four medical databases: CENTRAL, PubMed, LILACS, Science Ciation Index, and two trials registers: ICTRP Search Portal and ClinicalTrials.gov to 9 November 2018. We applied no language restrictions. Randomized and non-randomized studies comparing lateral pararectal versus transrectal stoma placement with regard to parastomal herniation and other stoma-related complications. Two authors independently assessed study quality and extracted data. We conducted data analyses according to the recommendations of Cochrane and the Cochrane Colorectal Cancer Group (CCCG). We rated quality of evidence according to the GRADE approach. Randomized controlled trials (RCT)Only one RCT met the inclusion criteria. The participants underwent enterostomy placement in the frame of an operation for: rectal cancer (37/60), ulcerative colitis (14/60), familial adenomatous polyposis (7/60), and other (2/60).The results between the lateral pararectal and the transrectal approach groups were inconclusive for the incidence of parastomal herniation (risk ratio (RR) 1.34, 95% confidence interval (CI) 0.40 to 4.48; low-quality evidence); development of ileus or stenosis (RR 2.0, 95% CI 0.19 to 20.9; low-quality evidence); or skin irritation (RR 0.67, 95% CI 0.21 to 2.13; moderate-quality evidence). The results were also inconclusive for the subgroup analysis in which we compared the effect of ileostomy versus colostomy on parastomal herniation. The study did not measured other stoma-related morbidities, or stoma-related mortality, but did measure quality of life, which was not one of our outcomes of interest.Non-randomized studies (NRS)Ten retrospective cohort studies, with a total of 864 participants, met the inclusion criteria. The indications for enterostomy placement and the baseline characteristics of the participants (age, co-morbidities, disease-severity) varied between studies. All included studies reported results for the primary outcome (parastomal herniation) and one study also reported data on one of the secondary outcomes (stomal prolapse).The effects of different surgical approaches on parastomal herniation (RR 1.22, 95% CI 0.84 to 1.75; 10 studies, 864 participants; very low-quality evidence) and the occurrence of stomal prolapse (RR 1.23, 95% CI 0.39 to 3.85; 1 study, 145 participants; very low-quality evidence) are uncertain.None of the included studies measured other stoma-related morbidity or stoma-related mortality. The present systematic review of randomized and non-randomized studies found inconsistent results between the two compared interventions regarding their potential to prevent parastomal herniation.In conclusion, there is still a lack of high-quality evidence to support the ideal surgical technique of stoma formation. The available moderate-, low-, and very low-quality evidence, does not support or refute the superiority of one of the studied stoma formation techniques over the other.