Evaluation Of Postoperative Complications Research Articles

Imaging Studies in Otosclerosis: An Up-to-date Comprehensive Review.

Introduction Otosclerosis is a primary osteodystrophy of the otic capsule, frequently responsible for acquired hearing loss in adults. Although the diagnostic value of imaging investigations in otosclerosis is debatable, they might still be employed with different goals within the context of the disease. Objectives The present paper aims to review the most recent literature on the use of imaging studies in otosclerosis for the most varied purposes, from routine application and differential diagnosis to prognostic prediction and investigation of surgical failure. Data Synthesis The diagnosis of otosclerosis is usually clinical, but computed tomography (CT) is paramount in particular cases for the differential diagnosis. The routine use, however, is not supported by strong evidence. Even so, there is growing evidence of the role of this method in surgical planning and prediction of postoperative prognosis. In specific scenarios, for example when superior semicircular canal dehiscence (SSCD) syndrome is suspected or in surgical failure, CT is crucial indeed. Magnetic resonance imaging (MRI), however, has limited – although important – indications in the management of individuals with otosclerosis, especially in the evaluation of postoperative complications and in the follow-up of medical treatment in active ostosclerosis. Conclusion Imaging studies have a broad range of well-established indications in otosclerosis. Besides, although the routine use of CT remains controversial, the most recent papers have shed light into new potential benefits of imaging prior to surgery.

Review and pictorial essay on complications of bariatric surgery.

Obesity is a chronic disease characterized by excess fat in the body and a real public health problem. Bariatric surgery, in recent decades, has gained space in its treatment due to the efficiency obtained in weight loss and significant reduction of the related comorbidities. The most commonly performed bariatric procedures include Roux-en-Y gastric bypass, adjustable gastric band, and laparoscopic sleeve gastrectomy. Possible complications described include fistulas, dehiscence, marginal ulcers, intestinal obstruction, internal hernias, and anastomotic stenosis. These complications may have unfavorable clinical outcomes since symptoms are often nonspecific. Abdominal computed tomography (CT) is an important tool in the evaluation of postoperative complications, both in the immediate and late postoperative status of patients undergoing such a procedure. We analyzed the most illustrative tomographic findings of the different complications after reducing gastroplasty in 203 patients without distinction of age or gender. Correct interpretation requires radiologists to understand the surgical technique since postoperative anatomy and surgery-specific complications may be obstacles to proper interpretation.

Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath.

Intractable hallucal ganglion cysts (HGCs) are often a symptomatic and recurrent condition. Its connection with the ankle joint is not well understood. Our aim was to evaluate the relationship between tenosynovitis of the flexor hallucis longus (FHL) tendon at the level of the ankle with formation of an HGC. In addition, we sought to analyze the outcomes of cyst excision combined with ankle capsulorrhaphy. Nineteen patients with HGC who underwent surgical intervention were included between June 2016 and June 2019. Eight had known recurrences. Ankle arthrography and cyst excision were performed on all patients. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and evaluation of postoperative complications. The mean follow-up period was 16.5 ± 8.6 months. Thirteen of the 19 HGCs (68.4%) had a connection with the FHL tendon sheath. Combined with ankle capsulorrhaphy, there was no recurrence after cyst excision. The VAS score decreased from 2.1 ± 1.5 to 0.4 ± 0.8, and AOFAS score significantly improved from 84.3 ± 8.7 to 97.4 ± 5.2 at final follow-up (P < .001). Most of these patients had a connection between the HGC and ankle joint. Ankle arthrography appeared to be useful for diagnosis, and cyst excision combined with ankle capsulorrhaphy was an effective treatment without cyst recurrence. Level IV, case series.

Value of Multi-Slice Computed Tomography in The Evaluation of Postoperative Complications After Laparoscopic Sleeve Gastrectomy

Background: Obesity is a medical condition that have an adverse effect on health. Bariatric surgery is considered nowadays as one of the most effective treatment for obesity. CT is one of the best modalities that is performed after a bariatric procedure to assess for complications. Purpose: The aim of this work was to highlight CT radiological features of postoperative surgical complications after laparoscopic sleeve gastrectomy (LSG) using abdominal multi-slice computed tomography (MSCT), and 3D volumetric rendering if needed. Patients and Methods: 182 patients with post sleeve gastrectomy suspected complications were subjected to CT of the abdomen and pelvis. Post-processing was performed with multi-planner reformation generating coronal and sagittal images together with the raw axial images for assessment of the integrity of the sleeved stomach and detection of any encountered complication with 3D reconstruction if needed to asses gastric pouch volume. Results: CT detected complications in 43 patients (23.6%) out of the 182 patients who underwent laparoscopic sleeve gastrectomy. The complications reported in our study were hematoma occurred in 13 patients (7.1%), leakage occurred in 10 patients (5.5%), abscess formation occurred in 6 cases (3.3%), splenic infarction occurred in 5 patients (2.7%), solid organ injury occurred in 2 patient (1%), Porto-mesenteric thrombosis occurred in 7 patients (3.8%), intestinal obstruction occurred in 2 cases (1%), port site ventral hernia occurred in 3 cases (1.6%), abdominal wall hematoma occurred in 3 cases (1.6%), enlarged gastric pouch occurred in 4 cases (2.2%), hiatus hernia occurred in 2 cases (1%). Conclusion: It could be concluded that sleeve gastrectomy became an increasingly popular surgery for obesity, so the radiologists must recognize and identify the normal postoperative anatomy as well as the possible complications of this procedure. MSCT with the 3D volumetric study is an important imaging tool to diagnose accurately the complications of sleeve gastrectomy.

Value of Multi-Slice Computed Tomography in The Evaluation of Postoperative Complications After Laparoscopic Sleeve Gastrectomy

Background: Obesity is a medical condition that have an adverse effect on health. Bariatric surgery is considered nowadays as one of the most effective treatment for obesity. CT is one of the best modalities that is performed after a bariatric procedure to assess for complications. Purpose: The aim of this work was to highlight CT radiological features of postoperative surgical complications after laparoscopic sleeve gastrectomy (LSG) using abdominal multi-slice computed tomography (MSCT), and 3D volumetric rendering if needed. Patients and Methods: 182 patients with post sleeve gastrectomy suspected complications were subjected to CT of the abdomen and pelvis. Post-processing was performed with multi-planner reformation generating coronal and sagittal images together with the raw axial images for assessment of the integrity of the sleeved stomach and detection of any encountered complication with 3D reconstruction if needed to asses gastric pouch volume. Results: CT detected complications in 43 patients (23.6%) out of the 182 patients who underwent laparoscopic sleeve gastrectomy. The complications reported in our study were hematoma occurred in 13 patients (7.1%), leakage occurred in 10 patients (5.5%), abscess formation occurred in 6 cases (3.3%), splenic infarction occurred in 5 patients (2.7%), solid organ injury occurred in 2 patient (1%), Porto-mesenteric thrombosis occurred in 7 patients (3.8%), intestinal obstruction occurred in 2 cases (1%), port site ventral hernia occurred in 3 cases (1.6%), abdominal wall hematoma occurred in 3 cases (1.6%), enlarged gastric pouch occurred in 4 cases (2.2%), hiatus hernia occurred in 2 cases (1%). Conclusion: It could be concluded that sleeve gastrectomy became an increasingly popular surgery for obesity, so the radiologists must recognize and identify the normal postoperative anatomy as well as the possible complications of this procedure. MSCT with the 3D volumetric study is an important imaging tool to diagnose accurately the complications of sleeve gastrectomy.

Methods of Colostomy Construction: No Effect on Parastomal Hernia Rate: Results from Stoma-const-A Randomized Controlled Trial.

The primary objective of this trial was to compare the parastomal hernia rates 1 year after the construction of an end colostomy by 3 surgical techniques: cruciate incision, circular incision in the fascia and using prophylactic mesh. Secondary objectives were evaluation of postoperative complications, readmissions/reoperations, and risk factors for parastomal hernia. Colostomy construction techniques have been explored with the aim to improve function and reduce stoma complications, but parastomal herniation is frequent with an incidence of approximately 50%. A randomized, multicenter trial was performed in 3 hospitals in Sweden and Denmark; all patients scheduled to receive an end colostomy were asked to participate. Parastomal hernia within 12 months was determined by computed tomography of the abdomen in prone position and by clinical assessment. Complications, readmissions, reoperations, and risk factors were also assessed. Two hundred nine patients were randomized to 1 of the 3 arms of the study. Patient demographics were similar in all 3 groups. Assessment of parastomal hernia was possible in 185 patients. The risk ratio (95% confidence interval) for parastomal hernia was 1.25 (0.83; 1.88), and 1.22 (0.81; 1.84) between cruciate versus circular and cruciate versus mesh groups, respectively. There were no statistically significant differences between the groups with regard to parastomal hernia rate. Age and body mass index were found to be associated with development of a parastomal hernia. We found no significant differences in the rates of parastomal hernia within 12 months of index surgery between the 3 surgical techniques of colostomy construction.

Evaluation of Post-operative Complications following Thyroid Surgery

Objectives: This study evaluates the incidence, Frequency and risk factors of complications in patients submitted to thyroidectomy for various benign and malignant lesion and to corroborate the results in relation to the extent of surgery in a Tertiary level hospital.&#x0D; Study design : An analytical study of 100 consecutive patients who underwent thyroidectomy for benign and malignant thyroid lesion.&#x0D; Material s and methods: The study was carried out at Department of ENT and Head-Neck surgery in Dhaka Medical College Hospital over a period of 1.5 years from January 2017 to June 2018. Data were collected from 100 patients who underwent thyroidectomies for various thyroid diseases at this center.&#x0D; Results: There were 80 females (80%) and 20 males (20%) with female-to-male ratio of 4:1, and The age range of the patients were 15 to 80 years, the mean age was 39.29 years. Preoperative diagnosis of benign and malignant pathologies was made in 86% and 14% cases respectively. Most common pathological diagnosis was colloid goiter 46%,nodular of cases, whereas papillary carcinoma accounting for 11% was the commonest malignant lesion .The types of thyroid operations done were as follows (Table-II). The commonest operation performed was hemithyroidectomy (45%). The overall postoperative complication rate was 17%.Temporary and permanent RLNI occurred in 3% and 2% respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in this study.&#x0D; Conclusion: In conclusion, extent of resection, surgical technique and thyroid pathologic condition had a greater impact on the rates of postoperative complications. By developing understanding of the anatomy and the ways to prevent each complication, the surgeon can minimize each patient’s risk and can handle complications expediently and avoid worse consequence.&#x0D; J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 108-113

CLO19-049: Central Lymph Node Dissection in the Clinically Node-Negative (cN0) Papillary Thyroid Carcinoma: Is it Necessary?

Background: Surgery is the treatment of choice in papillary thyroid cancer (PTC), which is the most common thyroid malignancy and frequently has metastases in the central compartment lymph nodes (CLN). There is debate among surgeons whether removing normal-appearing lymph nodes in the central neck (prophylactic lymph node dissection) is better than removing only the abnormal-appearing lymph nodes. Herein, we review the potential utility of central compartment lymph nodal dissection (CLND) on surgical outcome and disease-free follow-up of PTC and 5-year survival of patients operated on at our center. Methods: A total of 246 patients from February 2009 to March 2012 who were treated for PTC in our Kidwai Cancer Institution was analyzed retrospectively. 135 patients who underwent total thyroidectomy and CLND were assigned to Group A, which was compared with 111 patients who received total thyroidectomy, without CLND, who were assigned to Group B by evaluation of postoperative complications (recurrent laryngeal nerve damage, hoarseness, hypocalcemia, and hemorrhage rates) and recurrence at the time of Iodine131 treatment and subsequently at 60 months follow-up. Results: In the present study, Mean DFS and OS did not differ in both groups. Male gender and age more than 45 years had statistically significant DFS but without any impact on OS. There was a significant postoperative complication in group A compared to group B (P≤.001), with a very minimal recurrence in the central neck. 4 patients (3.6%) had recurrences in CLN. Conclusion: Considering the significant postoperative complication, which outweighs benefit, we conclude that for cN0 PTC, routine CLND is not necessary.

Prospective Evaluation of Postoperative Complications of Radical Cystectomy according to Clavien Dindo Classification: Laparoscopy Versus Conventional Surgery

Prospective Evaluation of Postoperative Complications of Radical Cystectomy according to Clavien Dindo Classification: Laparoscopy Versus Conventional Surgery

DIFFICULTIES OF SYSTEMATIZATION OF POSTOPERATIVE COMPLICATIONS OF ENDOSCOPIC TREATMENT FOR UROLITHIASIS AND THE SOLUTION WAYS OF THE PROBLEM

Actuality. Classification of postoperative complications Clavien-Dindo is designed to monitor complications and compare data between different centers. But for an objective assessment of complications, for each method of surgical treatment, a generally accepted norm of postoperative course should be developed, taking into account the specifics of the intervention. The absence of such a norm in the endoscopic treatment of urolithiasis leads to mistakes in the evaluation of postoperative complications. Purpose of research . Critical assessment of Clavien-Dindo grading system for surgical complications and its adaptation for evaluation of postoperative complications of endoscopic surgery for urolithiasis. Materials and methods. Retrospectively evaluated 1027 patients with urolithiasis who were operated endoscopically. The average age was 38.9 ± 15.6 (4 to 84) years. From the position of endoscopic surgery patients with “simple” stone were 446 (43.4 %), with “complex” — 581 (56.6 %). In 765 (74.5 %) patients stones were located in PCS, in PCS and ureter — in 60 (5.8 %), only in the ureter — in 202 (19.7 %). Size of stones in 1027 arranged 30.3 ± 0.6 (3 to 150) mm; located only in the ureter — 14.4 ± 0.5 (3 to 55) mm. From 1027 cases in 948 stones were removed via PC access (in the prone position), in 79 - transurethral. Regardless of the type of access only pneumatic lithotripsy were performed, which made possible to objectively evaluate the effectiveness of treatment in different groups. For systematization of complications Clavien-Dindo (2004) grading system was used. Results . Based on many years of experience of the RSCU’s staff in the endoscopic treatment of urolithiasis, as well by determining the category of complexity urinary stones from the position of endoscopic surgery, a clear boundary was determined between the normal postoperative period and the complicated one. Deviations from the standard of the postoperative period were found in 195 (19.0 %) patients with 250 complications, which were systematized by the way of critical evaluation and correction of the ClavienDindo classification: I – 64 (6.2 %), II – 111 (10.8 %), IIIa – 33 (3.2 %), IIIb – 39 (3.8 %), Iva – 3 (0.3 %), IVb – 0, V – 0. Conclusions. In order to optimally adapt the classification of surgical complications Clavien-Dindo, in relation to endoscopic surgery for urolithiasis, it was necessary to develop indicators standard of normal postoperative course of endoscopic treatment for urolithiasis. In turn, standard course must be accepted by Urology society. And only thereafter it will be possible to objectively compare the results of treatment between different centers. According to adapted Clavien-Dindo classification 70 % of complications of endoscopic treatment of urolithiasis were I - II grade and they were eliminated by conservative therapy, 30 % — attributed to grade III-IV, and to eliminate them were required additional invasive interventions and intensive care.

Risk stratification before thoracic surgery, perioperative pulmonary rehabilitation

Besides the oncology and operative surgical technics, functional aspects influence the operability of lung cancer. Preoperative risk stratification, evaluation of postoperative complications needs to be considered. To review international literature and experiences of our institute. We focused the literature of risk stratification of thoracic surgery. Lung function, lung mechanics, chest kinematics, exercise physiology were considered. Effectiveness of pulmonary rehabilitation for cardiovascular system, lung mechanics, muscles, exercise capacity and quality of life were evaluated. Laboratory parameters, comorbidities, obesity, cachexia, smoking cessation were considered. Elevated blood sugar, kidney function, reduced albumin level increased the risk. COPD, sleep apnoea, heart failure, obesity and cachexia influences the outcome. Smoking cessation may reduce postoperative complications. Controlled breathing technics, chest wall mobilization, training have favourable effects. Psychosocial support and dietetics are important. Risk stratification is supported by laboratory parameters, lung function, oxygen uptake and comorbidities. Pulmonary rehabilitation can improve functionality and quality of life. Orv Hetil. 2017; 158(50): 1989-1997.

SUN-P121: Application of Onodera Prognostic Nutrition Index and Neutrophilto Lymphocyte Ratio in Evaluation of Postoperative Complications in Patients with Crohn’s Disease

SUN-P121: Application of Onodera Prognostic Nutrition Index and Neutrophilto Lymphocyte Ratio in Evaluation of Postoperative Complications in Patients with Crohn’s Disease

Iatrogenic bile duct injury repair using isolated vascularized gastric tube: early experience in two tertiary centers

Background: Bile duct injuries (BDI) constitute a disaster for both the patient and the surgeon without satisfactory results with the classic use of roux-en-Y hepaticojejunostomy (RYHJ). The purpose of this study was to evaluate our newly introduced technique utilizing isolated vascularized gastric tube (IVGT) as an alternative for RYHJ in reconstruction of the bile duct after iatrogenic BDI with lost segment.Methods: This is a prospective study included 18 consecutive patients suffered from iatrogenic BDI with lost segment admitted to Assiut and Sohag University Hospitals, during the period from September 2013 to June 2016. Patients were subjected to operative treatment with the interposition of IVGT to bridge the lost bile duct segment. Patients were evaluated regarding demographic criteria, clinical picture, different investigations, efficacy of the use of IVGT and evaluation of post-operative complications after a mean follow-up of 2 years.Results: Eighteen patients underwent repair of BDI utilizing IVGT during the study period. Three patients (17%) suffered immediate repairs, 10 patients (55%) experienced intermediate repairs and late repairs were performed for the last 5 patients (28%). Bile leak as a specific early morbidity was present in 3 patients (17%) with upper biliary tract injury without any operative mortality. Also, there was one patient with stent obstruction relieved by stent extraction. With long-term follow-up there was not any patient of biliary stricture.Conclusions: IVGT proved to be feasible and safe for bile duct replacement and is a good alternative for biliary reconstruction being more anatomical and physiological than RYHJ.

Nutritional and functional factors as prognostic of surgical cancer patients

We evaluated phase angle, sarcopenia, and handgrip strength as prognostic factors of postoperative morbimortality in patients with cancer. We conducted a prospective study with 60 oncology patients admitted for elective surgery between November 2015 and May 2016. We calculated the standardized phase angle (SPA) and the skeletal mass index of the subjects based on their bioelectrical impedance tests. Handgrip strength (HGS) was measured using a hydraulic dynamometer. Diagnosis of sarcopenia followed the criteria of the European Working Group on Sarcopenia in Older People. The nutritional status of each subject was evaluated through the Patient-Generated Subjective Global Assessment. Evaluation of postoperative complications followed the Clavien-Dindo classification. We also evaluated the duration of hospital stay. Outcomes were postoperative complications and duration of hospital stay. The prevalence of malnutrition was 28.3%, and the prevalence of sarcopenia was 18.6%. The SPA was significantly lower among those who had severe postoperative complications or long hospital stays, while HGS and sarcopenia showed no relationship with these outcomes. Malnutrition was also related to postoperative outcomes. SPA can be considered a prognostic factor in postoperative morbimortality for patients with cancer.

Evaluation of postoperative complications according to treatment of third molars in mandibular angle fracture.

ObjectivesThe aim of this study was to evaluate the implication of third molars in postoperative complications of mandibular angle fracture with open reduction and internal fixation (ORIF).Materials and MethodsData were collected on patients who presented with mandibular angle fracture at our Department of Oral and Maxillofacial Surgery between January 2011 and December 2015. Of the 63 total patients who underwent ORIF and perioperative intermaxillary fixation (IMF) with an arch bar, 49 patients were identified as having third molars in the fracture line and were followed up with until plate removal. The complications of postoperative infection, postoperative nerve injury, bone healing, and changes in occlusion and temporomandibular joint were evaluated and analyzed using statistical methods.ResultsIn total, 49 patients had third molars in the fracture line and underwent ORIF surgery and perioperative IMF with an arch bar. The third molar in the fracture line was retained during ORIF in 39 patients. Several patients complained of nerve injury, temporomandibular disorder (TMD), change of occlusion, and postoperative infection around the retained third molar. The third molars were removed during ORIF surgery in 10 patients. Some of these patients complained of nerve injury, but no other complications, such as TMD, change in occlusion, or postoperative infection, were observed. There was no delayed union or nonunion in either of the groups. No statistically significant difference was found between the non-extraction group and the retained teeth group regarding complications after ORIF.ConclusionIf the third molar is partially impacted or completely nonfunctional, likely to be involved in pathologic conditions later in life, or possible to remove with the plate simultaneously, extraction of the third molar in the fracture line should be considered during ORIF surgery of the mandible angle fracture.

Complications of 2-Level Dynamic Stabilization: A Correlative Clinical and Radiological Analysis at Two-Year Follow-up on 103 Patients.

To investigate the postoperative complications, such as screw loosening, screw breakage and adjacent segment disease (ASD), in patients who underwent surgery with 2-level dynamic stabilization systems. Postoperative complications, clinical improvements and radiological parameters in patients who underwent surgery using a dynamic system for 2-level lumbar stabilization were retrospectively reviewed. A total of 103 patients with lumbar degenerative spinal instability underwent 2-level dynamic stabilization. Clinical findings were reviewed at 2-year followup. Screw breakage and loosening were evaluated during this duration together with clinical findings. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased at the four-month evaluation, and they were also decreased at the 1-year follow up and at the 24th postoperative month. ASD was diagnosed in twelve (8 females, 4 males) of the 103 patients in the follow-up radiological and clinical controls. There were 9 screw breakages and 4 screw loosening cases. The complication rate of 2-level dynamic stabilization was high in this study. Our results showed that complications (screw loosening or breakage and adjacent segment disease) are not rare after 2-level dynamic stabilization, unlike the acceptable results with the single-level dynamic system. The most probable explanation is that the instrument system behaves more rigidly with every additional segment.

Hepatectomy for Colorectal Cancer Liver Metastases in the Era of Modern Preoperative Chemotherapy: Evaluation of Postoperative Complications.

Recently, an increasing number of patients with liver metastases from colorectal cancer have received chemotherapy before hepatectomy. However, the effect of chemotherapy on postoperative short-term outcome is not well defined. We retrospectively investigated the postoperative complications of 439 patients who underwent hepatectomy for colorectal liver metastases in our division from 2005 to 2014. Patients were classified into two groups according to the presence (Cx; 84 patients) or absence (NCx; 355 patients) of preoperative chemotherapy. Univariate and multivariate analyses were conducted to determine the predictive factors for postoperative complications. There was neither mortality nor liver failure after surgery. There was no significant difference in the frequency of postoperative complications between Groups Cx and NCx [29 vs 26% for all complications; both 6% for bile leakage that required therapeutic intervention; and 2 vs 3% for Clavien-Dindo (CD) Grade≥IIIa, respectively]. In Group Cx, morbidity rates were similar among patients with different chemotherapy regimens. Chemotherapy-related factors (administration of bevacizumab, oxaliplatin or irinotecan, duration of chemotherapy >150days, and timing of hepatectomy) were not significantly associated with clinically relevant bile leakage and CD≥IIIa in multivariate analysis. Even after combination chemotherapy including targeted therapy, hepatectomy for colorectal liver metastases can be performed safely without increasing morbidity or mortality, if the patients fulfill the conventional criteria for surgery.

COMPARISON OF LAPAROSCOPIC AND OPEN METHOD OF TREATMENT AT PATHOLOGY OF THE VAGINAL PROCESS OF THE PERITONEUM

Abstract. The article contains literature review is devoted to the problem of hydrocele, comparison of different methods of treatment of patients with this pathology, and evaluation of postoperative complications.

COMPLICATION OF TOTAL THYROIDECTOMY PLUS LYMPH NODE GROUP VI DISSECTION IN PAPILLARY THYROID CARCINOMA PATIENTS

Background: Although lymph-node metastases are common in papillary thyroid cancer, there is considerable debate concerning the use of routine prophylactic lymph-node group VI dissection for all patients undergoing total thyroidectomy. This study was identification the complications and the rate of recurrence of total thyroidectomy plus lymph node group VI dissection in papillary thyroid carcinoma patients. Materials and methods: A prospective study was conducted on 60 patients with papillary thyroid carcinoma. They underwent total thyroidectomy with or without lymph node group VI dissection. Evaluation of postoperative complications and early recurrence rate /distant metastasis after 2 years. Results: The incident of transient hypoparathyroidism in the grouptotal thyroidectomy with or without lymph node group VI dissection respectively 13.3% and 6.7%. Neck lymph node dissection group VI helps detect 40.9% of cases of metastatic lymph nodes clinically undetectable. Neck lymph node recurrence rate in patients with lymph node group VI dissection is lower than group without dissection (3.3% versus 23.3%). Conclusions: Lymph nodes group VIdissection in preventive treatment of papillary thyroid carcinoma should be done. Key words: PTC, lymph-node group VI dissection

Shouldice herniorrhaphy – still an effective technique: A retrospective cohort study

AimOnly 4.8% of general surgeons in our country prefer Shouldice herniorrhaphy in primary inguinal hernia repair. In the evaluation of postoperative complications, this technique, which has the closest results to Lichtenstein herniorrhaphy, could be the preferred method in selected cases of primary inguinal hernia repair. It does not only provide an alternative to the surgeon, but it can also be the first choice in cases where mesh repair cannot be applied. In this study, we aimed to evaluate the efficacy of Shouldice herniorrhaphy in patients who got the primary inguinal hernia diagnosis, comparing Lichtenstein herniorrhaphy. Patients and methodOur study was done two-centred. We followed 48 patients who were operated with Lichtenstein technique for a diagnosis of primary inguinal hernia at the General Surgery Clinic of Erzincan Mengücek Gazi Training and Research Hospital between February 2011 and February 2014 and 42 patients who were applied Shouldice technique at Bulancak State Hospital General Surgery Department between January 2010 and February 2013. The patients were evaluated in respect of age, gender, hernia area, hernia type and early or late complications. FindingsIn respect of early complications, urine retention developed in only 2 (4.7%) patients of the Shouldice group. In the Lichtenstein group, complications developed in a total of 3 (6.3%) patients, as superficial infection was observed in 1 patient, seroma in 1 and urinary retention in 1. When we searched late-stage complications of the patients, paraesthesia developed in the inguinal area of 1 (2.3%) patient in the Shouldice group, and neuralgia developed in 2 (4.1%) patients of the Lichtenstein group. No recurrence was determined in any of the patients. ConclusionIn the repair of inguinal hernia, surgeons should not be tied to just one method. Shouldice herniorrhaphy is a good technique that could be the first choice when the use of mesh is not possible and could be an alternative to Lichtenstein herniorrhaphy when done appropriately. In surgical training, it should be considered after the Lichtenstein method in primary inguinal hernia repair.