Extensive Surgery Research Articles

A Case of CDKN2C/CIC Null Epithelioid Leiomyosarcoma With a Low-grade Component Indistinguishable From Leiomyoma.

Numerous emerging molecularly defined subtypes of uterine leiomyosarcoma (LMS) have been described in recent years. Here we report our experience with a challenging case of the recently described CDKN2C/CIC null subtype of LMS - a LMS subtype that is frequently epithelioid in appearance, is wild-type for both TP53 and RB1 and may exhibit low-grade histology that falls short of LMS. The 48-year-old patient was initially diagnosed with an epithelioid leiomyoma with a component of intravenous leiomyomatosis. Recurrence occurred 5 years later with an extensive disease burden in the abdomen and pelvis. Upon review, the lesion in the hysterectomy specimen and the recurrent tumor had similar morphology. This included (1) focal epithelioid morphology meeting current diagnostic criteria for epithelioid LMS and (2) other areas with morphology indistinguishable from leiomyoma (LM), including conventional spindle cell LM, cellular LM, and LM with bizarre nuclei. Targeted next-generation molecular analysis performed on both the original tumor in the hysterectomy specimen and the tumor from the recurrence showed the same CDKN2C/CIC null profile. This case highlights the striking intratumoral heterogeneity that is possible in CDKN2C/CIC null LMS, including areas morphologically indistinguishable from LM. Clinicopathological findings in this case, including features that may assist in recognizing this challenging LMS subtype, are discussed. We underscore the importance of early diagnosis, which can facilitate appropriate adjuvant and/or maintenance therapy that may decrease the morbidity associated with extensive debulking surgery.

Tracking Pleomorphic Adenoma Incidence Trends Over 47 Years: A Population-Based Study.

Tracking Pleomorphic Adenoma Incidence Trends Over 47 Years: A Population-Based Study.

Oncological Efficacy and Postoperative Outcomes of Low Grade Mucoepidermoid Carcinoma Treated With Partial Parotidectomy.

To assess the impact of extent of parotidectomy on surgical and oncologic outcomes in low grade mucoepidermoid carcinoma (LGMEC). A retrospective chart review of all patients undergoing primary surgical treatment for LGMEC from 2000 to 2022 was conducted. Clinical features collected included demographics, facial nerve function, operative techniques, postoperative complications/facial nerve function, and recurrence. 58 patients were included; 10 patients underwent partial parotidectomy (PP), 38 underwent superficial parotidectomy (SP), and 10 underwent near-total/total parotidectomy. PP and SP patients had smaller tumors and more superficial tumors compared to near-total/total parotidectomy group (P = .03). PP and SP were more likely to have negative margins and less locoregional disease compared to near-total/total parotidectomy patients (P < .01). Near-total/total parotidectomy were more likely to undergo facial nerve resection (20% vs 0% for PP & SP respectively) (P = .05). Immediate postoperative facial nerve function was significantly better among PP patients (73% HB I) compared to SP (44% HB I) and near-total/total parotidectomy patients (0% HB I) (P < .01). Most patients regained their facial nerve function although only 40% of the near-total/total parotidectomy patients had a HB I at the time of last follow up (P < .01). Patients were followed for a median of 6.2 years, during which only 1 patient (total parotidectomy) had a recurrence. PP offers a safe and effective approach for small LGMEC tumors, ensuring better facial nerve function postoperatively with minimal complications compared to more extensive surgery.

Endoscopic Surgery for the Treatment of Osteodiscitis: A Systematic Review

Spondylodiscitis is a serious spinal infection that can cause spinal instability, neurologic deficits, and paralysis. Although endoscopic procedures are becoming increasingly common, their role in spondylodiscitis management remains undefined. In this systematic review, PubMed, Embase, and MEDLINE were searched for studies published from January 1950 to March 2024 on percutaneous endoscopic debridement and drainage (PEDD) surgery for spondylodiscitis. The inclusion criteria included clinical trials or case series of spondylodiscitis patients treated with endoscopy. Primary outcomes included culture yield, complications, reoperations, treatment success rates, and pain scores. Our review included 40 studies that assessed 667 patients. Most studies presented low-level evidence, consisting of case reports (40.0%) and case series (60.0%). Endoscopic techniques demonstrated a positive culture yield of 67.3%, with an overall complication rate of 7.8% (95% confidence interval [CI], 5.35%–10.47%) and a reoperation rate of 13.1% (95% CI, 10.08%–16.31%). There were no complications related to cerebrospinal fluid leaks or meningitis. The medical treatment success rate was higher in patients who underwent concurrent instrumentation than in those who received endoscopic debridement alone (96.4% vs. 85.9%, p=0.003). Thirteen studies presented patient-reported pain outcomes, and all cohorts showed improvements. This review suggests that PEDD shows promise as a safe and effective adjunctive treatment for spondylodiscitis, offering low complication rates and successful treatment. PEDD may play a role within a multidisciplinary treatment approach. Future clinical trials are needed to determine whether early PEDD can improve the overall success of medical therapy and reduce the need for more extensive debridement and fusion surgery.

Learning Curve on Lymph Nodes Retrieval and Postoperative Length of Hospital Stay in Robotic Rectal Cancer: A Retrospective, Observational Study.

Robotic rectal cancer surgery has been introduced to reduce the difficulty and complications of the procedure. This study aims to assess the learning curve for robotic rectal cancer of individual surgeons with extensive laparoscopic rectal cancer surgery through multidimensional analyses. Data were retrospectively collected on 156 patients who underwent robotic rectal cancer surgery by a single surgeon between January 2018 and December 2023. The operative time required for LAR can be divided into three distinct phases: an early or learning phase (1-24 cases), an intermediate or proficient phase (25-55 cases), and a late or mastery phase (56-72 cases). The study found that the learning curve for LAR and protective operative time can be divided into three distinct phases: an early or learning phase (1 to 15 cases), an intermediate or proficient phase (16 to 40 cases), and a late or mastery stage (41 to 63 cases). Following the completion of 46 cases of surgery, the next stage of the learning curve for lymph nodes retrieval has been reached. The discrepancy between the mean number of lymph nodes retrieved in each of the three stages was marginal, with an difference of 0.5 between the lowest and highest values observed (14.1 vs. 13.6 vs. 13.7). The length of hospital stay for patients decreases as the surgeon gains more experience, reaching a mean of 10.3 days in 2023. This study shows that robotic surgery for rectal cancer has a significant learning curve with multiple stages. Robotic surgery can remove more lymph nodes than recommended by guidelines even during the learning phase (recommend that at least 12 lymph nodes should be retrieved). As the learning curve progresses to the mastery phase, the length of postoperative hospital stays gradually decreases to a lower level.

Electrospun Decellularized Skeletal Muscle Tissue/Polycaprolactone/Polyaniline as a Potential Scaffold for Muscle Tissue Engineering.

Skeletal muscle tissue is capable of self-healing on a small scale. However, during extensive trauma or surgery, regenerative capacities are lost due to the loss of muscle cells and extracellular matrix. Therefore, the development of tissue engineering strategies for the regeneration of muscle tissue should be considered. In this study, we electrospun decellularized skeletal muscle tissue (DSM)/polycaprolactone (PCL)/polyaniline (PANi) as a bioactive polymer composite and investigated the structural characteristics, physicochemical properties, and effect of PANi on these properties. Next, the biological and myogenic effects of scaffolds on human Wharton's jelly mesenchymal stem cells (hWJ-MSCs) were investigated. The results showed that DSM/PCL/PANi is a conductive fibrous scaffold with favorable physical and chemical properties for muscle tissue engineering; it is biocompatible with hWJ-MSCs and stimulates their morphology. Additionally, hWJ-MSCs cultured on DSM/PCL/PANi showed a significant increase in the expression of MyoD, Myogenin, and MHC. Laboratory experiments showed that the electrospun scaffold of DSM/PCL/PANi is biocompatible with favorable physical properties for the growth of stem cells and the expression of myogenic markers, which can be useful in the development of biological scaffold approaches for muscle tissue engineering.

The treatment of idiopathic and non-idiopathic vertical talus using the Dobbs method- a long- term study with a follow-up of up to 16 years- relapses, residual deformities and reoperations.

Treating vertical talus using the minimally invasive method according to Dobbs is becoming increasingly more common and appears to reduce the need for extensive surgery. In this paper, we report on the long-term findings for treating these idiopathic and non-idiopathic deformities. Twenty-three vertical talus deformities were treated between 11/2007 and 12/2014. Treatment was primarily carried out using the minimally invasive Dobbs method with reverse Ponseti casting. Patient data, treatment data, surgical methods, relapse rates, functional results and weight-bearing imaging results were documented over the course of the study. The talar axis-first metatarsal base angle (TAMBA) was used to assess the severity of the deformity. Long-term clinical findings and imaging were presented. Nineteen vertical talus deformities were examined over an average follow-up period of 10.4 years. A minimally invasive primary correction was performed on 74% using the Dobbs method. More extensive surgical measures were necessary in 26,3%. The relapse rate was 26.3%. In the group with idiopathic deformities the average long-term range of motion of the ankle joint was 17.5° dorsiflexion and 36° plantarflexion, in the group with non-idiopathic deformities it was 9.2° dorsiflexion and 12.4° plantarflexion. The average preoperative TAMBA for the entire cohort was 65°; postoperatively it was 13°. In the group of feet that underwent a minimally invasive correction procedure, these values were 51° preoperatively and 11° postoperatively. In 79% we achieved excellent and good results according to the radiological classification system of Hamanishi over the long term. Using the minimally invasive Dobbs method to treat vertical talus significantly reduces the need for extensive surgery and also leads to good, long-term functional results, especially for idiopathic deformities. More extensive arthrolysis to correct the deformity may still be warranted in cases of non-idiopathic deformities. Non-idiopathic deformities, residual pathologies, and changes in foot deformity not related directly to a vertical talus pathology leads to higher long-term reoperation rates.

Single mandibular midline-implant supported overdentures: Fifteen-year clinical outcome.

Single mandibular midline-implant supported overdentures: Fifteen-year clinical outcome.

Pilot study of a novel resection extent determination method using bone single-photon emission computed tomography-standardized uptake value in medication-related osteonecrosis of the jaw.

Surgery is the standard treatment for medication-related osteonecrosis of the jaw (MRONJ). However, there are few reports on the appropriate extent of the bone resection. This pilot study explores the feasibility of a new method for estimating the extent of resection using bone single-photon emission computed tomography (SPECT)-standardized uptake value (SUV). We retrospectively analyzed 8 MRONJ patients who underwent curettage (n = 2), curettage with removal of the separated sequestrum (n = 2), or marginal resection (n = 4) as part of extensive surgery. The resected regions were compared with the regions estimated using SPECT-SUV. The agreement between the SPECT cold region and the resected region was evaluated using the Dice coefficient (defined as the ratio of 2 × overlap volume to resected volume plus SPECT cold region volume), overlap ratio, and volume ratio. The inclusion of CT findings (osteolytic, gap- and irregular-type periosteal reactions, and mixed-type osteosclerosis) in the estimated region was also evaluated. Additionally, histopathological findings from 3 marginal resection cases were used to validate the estimated region. In all cases, the resected region included the cold regions observed on bone SPECT, with radiotracer accumulation confirmed around the resected region. CT-osteolytic regions were included within the estimated region. The Dice coefficient was 0.53 ± 0.10, the overlap ratio was 86.7 ± 7.2%, and the volume ratio was 235.0 ± 74.7%. Histopathological analysis revealed significant osteocyte necrosis in cold regions, whereas areas with an SUV of 9 displayed normal osteocytes, newly formed bone, and mild inflammatory cell infiltration. This study suggests that the setting of the SPECT-cold region using bone SPECT-SUV may allow for the estimation of the extent of resection in early-to-intermediate-stage MRONJ.

Epidural anesthesia in thoracic and abdominal surgery : Current perspectives and practical implications

With the rise of minimally invasive and robot-assisted surgical techniques, the role of epidural anesthesia (EA) in modern practice necessitates careful re-evaluation. This review explores the relevance of EA in thoracic and abdominal surgery, examining its practical applications, residual indications and considerations for its use. Additionally, alternative pain management strategies, including systemic analgesia, regional nerve blocks and novel perioperative approaches, are assessed for advantages and limitations compared to EA.Traditionally the gold standard for perioperative pain control in thoracic and abdominal procedures, EA provides superior analgesia, reduced pulmonary complications and promotes early postoperative mobilization; however, the shift towards less invasive types of surgery has raised questions about the necessity and risk-benefit profile of EA. Complications such as hypotension, hematoma and rare neurological injuries emphasize the importance of thorough risk assessment.Emerging data show that alternative methods, such as transversus abdominis plane (TAP) blocks, paravertebral blocks and multimodal analgesia provide comparable efficacy in specific patient groups while often demonstrating abetter safety profile. Nevertheless, EA remains essential in extensive thoracic surgery, complex abdominal resections and in patients with a high risk for severe postoperative pain or respiratory compromise. Combining EA with enhanced recovery after surgery (ERAS) protocols has also shown promise in improving outcomes.In conclusion, while minimally invasive surgical techniques have transformed perioperative care, EA retains acritical role in selected indications. Individualized planning of anesthesia, weighing EA against evolving alternatives and tailored to surgical and patient-specific factors, is essential. This review highlights the integration of evidence-based strategies to optimize the role of EA in contemporary surgical treatment.

New Challenges in the Diagnosis and Treatment of Primary Cutaneous Aspergillosis in Extensive Pediatric Burns.

The aim of this study is to share our experience regarding the diagnosis and therapeutic management of primary cutaneous aspergillosis (PCA) in the burn patient, an uncommon infection associated with increased mortality, morbidity, and treatment costs. The uniqueness of this article is the presence of PCA in pediatric patients where the Meek micrografting technique was used. We performed a retrospective study from June 2020 to November 2024. The inclusion criteria were the concomitant presence of burn injuries and confirmed PCA. We identified six patients, aged between 12 and 17 years, admitted with deep burns ranging from 55% to 90% of the total body surface area (TBSA). They required complex ICU treatment and underwent extensive excision-grafting surgeries. The suspicion of infection was raised by changes in the appearance of wounds. Systemic and topical antifungal treatment was established in patients after a PCA diagnosis. Five out of the six cases had a favorable outcome. The use of the Meek micrografting technique in burn treatment represents a new challenge in the treatment of PCA due to the polyamide gauze that covers the micrografts. Early detection and appropriate topical antifungal agents combined with systemic treatment may save the infected grafts and limit the infection spread without necessarily removing the polyamide gauze.

Treatment outcomes after pelvic exenteration with IGAM or VRAM flap reconstruction: Review of 130 consecutive cases.

Treatment outcomes after pelvic exenteration with IGAM or VRAM flap reconstruction: Review of 130 consecutive cases.

Understanding the Psychological Impact of Medical Care Experiences on Adults With Craniofacial Conditions: A Pilot Survey of Traumatic Stress Symptoms and Resilience.

Craniofacial conditions often require extensive medical care and surgeries throughout childhood and adolescence. However, there is limited research investigating the psychological effects of craniofacial care, including risks for medical traumatic stress. This cross-sectional study investigated the medical care experiences of adults with craniofacial conditions, including the frequency of potentially traumatic medical events, post-traumatic stress disorder (PTSD) symptoms, and resilience. Participants (N=34; mean age 35.2 ± 12.2y; 71% female) were recruited at 3 US pediatric hospitals and craniofacial support organizations. Participants completed the PTSD Checklist (PCL-5), Connor-Davidson Resilience Scale, the Craniofacial Experiences Questionnaire, and open-ended questions about their medical care experiences. Most participants reported experiencing potentially traumatic medical experiences, such as prolonged and/or painful dental (79%) and medical treatments (73%) and hospitalization in the intensive care unit (70%). On the PCL-5, 21% met the criteria for PTSD, which is similar to other medical populations and higher than the 6% rate of PTSD in the general US population. Participants reported both stressors and positive aspects related to living with a craniofacial condition; however, resilience scores were lower relative to a US community sample. Qualitative analysis of open-ended responses identified themes including interactions with providers, medical treatment experiences, and psychosocial impacts. Adults with craniofacial conditions appear to be vulnerable to post-traumatic stress symptoms related to their medical care experiences, and report reduced resilience relative to community samples. Implications for clinical care and research include the integration of trauma-informed care approaches and strategies to support coping and resilience across the lifespan.

An open intensive care unit (ICU) model is a viable option for the acute expansion of ICU capacity in the state sector: A study of a needs-based strategy during the COVID-19 pandemic in a tertiary ICU in South Africa.

Both open and closed intensive care unit (ICU) models are used in South Africa (SA). The literature is unclear with regard to which model is superior. The COVID-19 pandemic led to a critical care resource crisis that necessitated expansion of critical care capacity, often beyond the resources required to meet the structure of a closed ICU in the institutions using that model. This retrospective study aimed to compare the outcomes of non-COVID patients in a closed ICU setting and a temporary open unit that ran parallel to it during the pandemic, in order to assess this type of resource expansion as a viable option. Data from the Intensive Care Electronic Record System in the Greys Hospital ICU in Pietermaritzburg, SA, were analysed for patients aged ≥12 years admitted to either the open or the closed ICU between April and August 2020. Data missing from the database were completed by referring to the medical records office. The primary outcome assessed was mortality, while secondary outcomes included adverse events and hospital length of stay. There was no significant mortality difference between the ICU components (16.9% in the open-model group v. 15.1% in the closed model group; p=0.769). The incidence of adverse events also did not differ (45.5% in the open model v. 38.9% in the closed model; p=0.357). Patients requiring ICU admission have complex conditions or have undergone extensive surgery, necessitating specialised treatment and careful monitoring. In the event of an acute surge event, expanding ICU capacity by adding an open-model component in a setting that traditionally runs closed models may be an effective strategy to assist in the management of critically ill patients without significantly affecting outcomes. What the study adds. This retrospective study compared outcomes of non-COVID patients in a closed intensive care unit (ICU) v. a temporary open unit during the pandemic. The efficacy of open v. closed ICU models remains uncertain in the South African context. The study offers insights into the effectiveness of open and closed ICU models, particularly in the context of crises during which institutions may face a critical care resource shortage.Implications of the findings. The study suggests that incorporating open ICU units during crises can manage patient surges effectively without compromising outcomes. It contributes to the existing literature by providing practical implications for resource management, clinical practice and future research, ensuring quality patient care while optimising critical care capacity.

The effects of obesity on surgical complications and postoperative prognosis of epithelial ovarian cancer: a meta-analysis

ObjectiveTo comprehensively evaluate and compare surgical outcomes of obese patients versus non-obese patients for surgical complications and postoperative prognosis due to epithelial ovarian cancer (EOC).MethodsStudies were obtained from database search systems of Medline (PubMed) and Embase. Data were analyzed by the meta-analysis method and the random-effect or fixed-effect model. The heterogeneity between the studies was evaluated by I2 index and the data were analyzed using STATA version 15.1 and Review Manager version 5.4.Results14 studies with 4858 cases of proven epithelial ovarian cancer who underwent extensive surgery were included. Obesity may be a risk factor of the low surgical complex score (RR1.08, 95% CI 1.01–1.15, p = 0.05), but had no manifesting difference in the surgical complications score compared non-obesity group (RR 0.50, 95% CI 0.07–3.79, p = 0.501 and RR 0.60, 95% CI 0.22–1.63, p = 0.316). Obesity EOC patients who undergone surgery tended to be correlated with surgical complications, such as wound infection (RR 2.71, 95% CI 1.59–4.61, p = 0.000), intestinal complications (RR 2.09, 95% CI 1.00-4.35, p = 0.000), and 30-readmission rate (RR 1.84, 95% CI 1.16–2.93, p = 0.000). Obese patients were more likely to have shorter prognosis free survival (PFS) (SMD 0.62-year, 95% CI-0.13 to 0.15), but the results did not discover a significant difference in overall survival (OS)between obesity and non-obesity. (SMD 0.01-year, 95% CI-0.13 to 0.15)ConclusionsObesity affects the difficulty of ovarian cancer surgery, and a negative relationship between obesity and surgical complications is observed. Obesity is a potential risk factor for prognosis of EOC patients. Attention is played on determining what kind of case should be benefit most from this surgery to minimize the rates of operative complications and postoperative mortality.PROSPERO registration numberCRD 42,023,434,781.

Acute Upper Extremity Deep Vein Thrombosis Following Extensive Nasal Reconstruction Surgery: A Case Report.

Upper extremity deep vein thrombosis (DVT) is an uncommon complication in plastic surgery, with a high potential for misdiagnosis due to its rarity. This case report describes a 21-year-old male who developed upper extremity DVT after a comprehensive nasal reconstruction surgery. Despite an initially uneventful procedure, the patient presented with significant pain and swelling in his right arm on the first postoperative day. Doppler ultrasound confirmed acute thrombosis in the brachial, ulnar, and radial veins. Timely anticoagulation therapy led to symptom resolution and thrombus clearance. This case underscores the importance of early recognition and management of upper extremity DVT in postoperative patients to prevent complications. Clinicians should maintain a high index of suspicion for DVT in patients with postoperative extremity pain and swelling, regardless of its perceived rarity.

Bone regenerative medicine: An emerging field with opportunities and challenges

AbstractThe global prevalence of bone disorders has significantly increased and is projected to double by 2024. In many instances, addressing bone defects requires extensive surgical procedures, including bone grafting techniques that often result in prolonged healing times, a heightened risk of infection, and considerable pain, with no assurance of complete recovery. Bone tissue engineering (BTE) scaffolds are emerging as a promising alternative to conventional bone grafting due to their abundant availability and absence of disease transmission. The primary aim of BTE is to encourage the regeneration of functional bone through a synergistic approach that combines biomaterials, cells, and therapeutic factors. One major challenge in this field is ensuring proper integration of the implanted biomaterials with the host tissue and promoting vascularization to provide adequate nutrients to the newly formed tissue. Additionally, factors such as biodegradability, biocompatibility, bioactivity, and cost‐effectiveness of 3D porous scaffolds are still not optimal. This review discusses the basics of BTE and highlights the current landscape of the field, focusing on existing technological and clinical opportunities and challenges. Furthermore, it aims to illustrate the current advancements in BTE using various construction materials and recent scientific findings in the area.

Damage control does not offer a survival advantage and increases the risk of serious complications compared with early total care in severely injured patients with femoral shaft fractures.

Damage control orthopedics (DCO) was proposed to minimize the second hit of extensive surgical procedures in severely injured patients when treated with early fracture fixation (early total care [ETC]). The impact of DCO and ETC on the outcomes of severely injured patients sustaining femoral shaft fractures (FSFs) is unclear. We hypothesized that DCO is associated with lower mortality and decreased incidence of complications compared with ETC. The Trauma Quality Improvement Project database was queried from 2007 to 2021. Adult patients 14 years or older with FSF and Injury Severity Score of >15 were included. Patients were divided into ETC and DCO groups and stratified according to fracture type: open or closed. The primary outcomes included acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), severe sepsis, deep venous thrombosis (DVT), and mortality. Inverse probability treatment of weighting was used to balance the two cohorts of interest. A binomial logistic regression analysis was performed after inverse probability treatment of weighting to identify potential associations between the type of fixation procedure and the outcomes of interest. A total of 44,577 FSF patients were included. Mortality was 2.1%. No survival advantage was observed in the DCO group (odds ratio [OR], 0.92). However, significant associations between DCO and the risk of ARDS (OR, 1.64), AKI (OR, 1.57), severe sepsis (OR, 1.64), and DVT (OR, 1.64) were identified. Damage control orthopedics was not associated with decreased mortality after stratifying patients according to the fracture type and the type of operation. Damage control orthopedics is not associated with improved survival of severely injured patients with FSF. Damage control orthopedics is associated with an increased risk of ARDS, AKI, severe sepsis, and DVT compared with ETC. These findings persisted after analyzing the type of fracture. These results are significant for clinical practice, as more patients could be treated by ETC when compensated physiologically, independent of the fracture type. Therapeutic/Care Management; Level IV.

Surgical Correction for Adolescent Idiopathic Scoliosis : A Case Series of 139 Consecutive Patients Treated in Neurosurgical Department.

This study aimed to evaluate the clinical and radiographic results of patients with adolescent idiopathic scoliosis (AIS) operated by a single neurosurgeon. A total of 139 consecutive patients with AIS who underwent corrective surgery by a single neurosurgeon were investigated between January 2011 and January 2024. Segmental instrumentation with pedicle screws was utilized for deformity correction. Demographic information, structural type of curve using Lenke classification, degree of correction achieved, total numbers of fusion levels, complications, and clinical/radiographic results were evaluated. Most patients were adolescent girls (105 vs. 34) with an average age of 15.9 vs. 16.0, respectively. The average duration of follow-up was 4.5 years (0.1-13.0 years). Nine (6.6%) patients had levoscoliosis, and the remaining 130 had dextroscoliosis. Chiari malformation with syringomyelia was incidentally diagnosed in four (2.8%) patients. Of the patients having Chiari malformation, two (50%) had levoscoliosis. The mean number of fused levels was 11.2. The mean value of the Cobb angle at the major structural curvature was 63.4° (43°-125°). The major structural curve's average percentage of correction was 78.8%. The final postoperative SRS-22 average score significantly improved to 4.3±0.4 compared with the preoperative score of 3.8±0.5 (P < 0.001). After the surgery, there were no observed cases of neurological deficits or need for screw repositioning. Revision fusion extension surgery was performed on one patient to treat postoperative shoulder imbalance. Patients with AIS treated by a neurosurgeon had acceptable clinical and radiographic results. However, AIS surgery necessitates a fundamental comprehension of pediatric spinal deformities, which is crucial. Furthermore, spine surgeons should be careful with patients who have levoscoliosis.

Double-Barrel Urocolostomy After Pelvic Exenteration: Short-Term Morbidity and Patient-Reported Quality of Life

BackgroundTotal pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies. Traditionally, an ileal conduit is created on the right abdominal wall for urinary diversion and an end-colostomy on the left abdominal wall for fecal diversion. However, this approach is associated with increased morbidity and a negative impact on quality of life (QoL). A unilateral double-barrel urocolostomy (DBUC) offers an alternative using the sigmoid colon for urinary drainage. This can potentially reduce complications, improve QoL, and preserve the right vertical rectus abdominis muscle (VRAM) flap for pelvic reconstruction. This study aimed to evaluate the impact of the DBUC on 90-day morbidity and QoL of patients undergoing pelvic exenteration for locally advanced colorectal and anal cancer.MethodsData were prospectively collected from all patients who underwent pelvic exenteration with DBUC reconstruction for colorectal and anal cancer at our tertiary care center between January 2020 and May 2023.ResultsThis study enrolled 20 patients. Postoperative complications were observed in 19 patients, including seven major complications. Two complications were directly attributable to the DBUC. Patients reported favorable QoL outcomes in terms of global health, functional ability, and symptom management, with expected limitations in physical performance due to extensive abdominal surgery. At 1 year after surgery, all the patients preferred the DBUC over separate bilateral ostomies.ConclusionThe DBUC procedure has demonstrated safety and efficacy in terms of short-term morbidity and favorable patient-reported QoL, making it an attractive alternative to dual ostomies for patients undergoing pelvic exenteration, particularly when VRAM reconstruction is considered.